Anticoagulants

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fusser
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208187
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Anticoagulants
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2013-03-19 00:43:27
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anticoagulants drugs
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Anticoagulants, test 3
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  1. Anticoagulants
    • Not blood thinners!
    • General use: prevention & treatment of thromboembolic disorders including DVTs, pulmonary embolism, & atrial fibrillation with embolization. Also used in management of MI sequentially or in combination with thrombolytics and/or antiplatelet agents.¬†
    • Used to prevent clot formation
    • They Do Not dissolve clots
    • Monitor pt for signs of bleeding, PT-INR, aPTT
    • Avoid alcohol and NSAIDS
  2. Heparin
    • Accelerates the rate that antithrombin III neutralizes thrombin and factor x
    • Low dose- prevents conversion of prothrombin to thrombin
    • High dose- prevents conversion of fibrinogen to fibrin
    • Monitor aPTT (activated partial thromboplastin time) goal is 1 1/2 to 2 x control/normal
    • Given IV or SQ (IV immediate onset short half life, SQ rapid onset 20-60min, given in abd
    • IV dose based on APTT resulst q6 hours till stable then daily (weight based nomograms allow nurse to adjust dose based on pt weight and APTT result)
    • SQ low dose, q8-12 hours, less monitoring required
    • Adverse effect: GI/GU bleed
    • High alert medication verify dose with 2nd nurse
    • D/C 12-24 hours before surgery
  3. Protamins Sulfate
    • Neutralizes heparin activity
    • Given for life threatening hemorrhage
    • Slow IV infusion
    • Risk of anaphylaxis
  4. HIT
    Heparin Induced Thrombocytopenia
    • White clot syndrome
    • Monitor platelet counts
    • Immune reaction to heparin
    • D/D heparin if thrombocytomenia (platelet drop by 50%)
    • Onset usually 5-22 days on heparin (o.5% pf pts)
  5. Enoxaparin (Lovenox)
    Low Molecular Weight Heparin

    • less effect on thrombin, allows SQ admin based on weight w/o lab monitoring
    • used to prevent DVT
    • Adverse: bleeding, thrombocytopenia, elevated AST, ALT
    • Monitorplatelet and report drop in platelet count
  6. Lepirudan (refludan)
    • Parenteral anticoagulant
    • direct thrombin inhibitor
    • used for pts with HIT
    • IV dosing- monitor APTT
    • caution w/renal insufficiency
  7. Coumadin (warfarin)
    • Interferes with hepatic synthesis of vitamin K dependent clotting factors (II, VII, IX, X)
    • inhibits thrombus formation & extension
    • Prolongs prothrombin time & APTT
    • 72 hours or more to reach adequate anticoagulation
    • 2-7 days to stabilize
    • May overlap therapy w/heparin
    • PO primarily--IV rarely
    • Reduce risk of stroke or MI
    • Adverse: bleeding, usually due to OD, rare GI upset (n/v/d, cramps), elevate liver function tests
    • Caution with other drugs causing bleeding: aspirin, NSAIDSa, ETOH, corticosteroids, other anticoagulants
    • Antibiotics decrease bacterial activity in gut; decrease synthesis of vitamin K; increase coumadin effect (prolong prothrombin time)
    • Nursing Implications: monitor prothrombin time, want 1 1/2 to 2 x control; INR goal is 2.0--3.0
    • Diet caution vitamin K intake
    • Monitor for bleeding
    • No meds w/o dr approval
    • No IM injections
    • Not safe in pregnancy
    • D/C 4-7 days before surgery based on INR
    • Keep app for lab work
    • VITAMIN K- reversal agent when INR >5
    • PO for INR 5-8; IV infuse vitamin K for INR >8
    • risk of anaphylaxis greater w/IV- reserve for hemorrhage & INR>8
    • Severe bleeding give fresh frozen plasma to restore clotting factors


  8. Abciximab (reopro)
    • Platelet Aggregation Inhibitor
    • Blocks platelet aggregation
    • Inhibits binding of fibrinogen to platelets
    • Given IV after MI, angioplasty, or stent placement to prevent occlusion
    • Adverse: rash, GI upset, bleeding disorder
  9. Clopidogrel (plavix)
    • Platelet Aggregation Inhibitor
    • Antiplatelet agent
    • Less toxicity, leukopenia, thrombocytopenia
    • Interaction: clopidogrel & omeprazole - increased mortality
  10. Platelet Aggregation Inhibitor
    • Blocks platelet aggregation
    • Inhibits binding of fibrinogen to platelets
    • Prolongs bleeding time
    • Used to prevent MI or stroke
    • Adverse: rash, GI upset, bleeding disorders
  11. Pradaxa (dabigatran etexilate)
    • Inhibits thrombin
    • Used to prevent stroke & clots in pts with Afib
    • Compare w/coumadin- pts had fewer strokes
    • Blood level monitoring not necessary
    • Adverse: bleeding
    • GI symptoms- dyspepsia, pain, nausea, heartburn, bloating
  12. Acetylsalicylic Acid (Aspirin)
    • In platelets blocks production of thromboxane A2- an inducer of platelet aggregation. Since platelets don't synthesize, action on platelets is permanent (life span of platelet 7-10 days)
    • Repeated doses have cumulative effect
    • Doses 80-160 mg/day
    • More effective given BID in diabetics
    • Prevent stroke & MI in high risk pt
    • Adverse: allergy, bleeding (especially GI)
  13. Fibrinolytic Agents
    Clot Busters
    • Tissue Plasminogen Activators
    • Plasminogen when activated becomes a protease-¬†binds to fibrin-¬†fibrinolysis
    • tPA activates bound plasminogen vs free; targets clots

    • Hepatically metabolized
    • Short half life
    • Given IV bolus, then infusion over 1 hour
  14. tPA (alteplase, activase)
    • Recombinant variations of tPA- reteplase & tenecteplase
    • Longer half lifes- give in 2 IV boluses
    • Similar efficacy & toxicity
    • Use: Thrombolysis in MI, CVA, pulmonary embolus
    • Risk: bleeding. Usually given w/ASA, heparin
  15. Contraindications of tPA
    • Risk of Bleeding
    • 1- surgery w/in 10 days, trauma, CPR
    • 2- GI bleed w/in 3 months
    • 3- Hypertension, uncontrolled (diastolic >110)
    • 4- Active bleeding or hemorrhagic disorder
    • 5- Previous CVA or acute intracranial process
    • 6- Aortic dissection
    • 7- Acute pericarditis
    • Administer IV in ICU or ER w/cardiac monitoring
    • Observe for s/s bleeding- GI,GU,IV sites, risk of CVA
    • Observe for therapeutic response; MI- ekg changes, CVA- recovery of neuro function, pulmonary embolism- improved oxygenation

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