Anticoagulant Therapy

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Anticoagulant Therapy
2014-06-26 00:04:00

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  1. Antiplatelet agent
    • Prevent platelet aggregation
    • uses: reducing platelet clustering, prevent thromboembolic events, prevent of reocculusion following bypass

    • Plavix (clopidogret
    • asprin
    • persantine
  2. Antiplatelet (plavix)
    Ex. Plavix

    • MOA: prevents platelets from clustering. Adenosine Diphosphate Receptor antagonist. 
    • inhibits the binding of ADP to the platelet receptor. 
    • irrevesibly binds to platelet- last life time of platelet 21 days
    • pro-drug- inactive form
    • effects are individual
  3. Plavix CI
    • reduces atheroscierotic events- pt with cardiac hx or PVD
    • reduce the risk of occulsion after CABG
    • can be administer with aspirin for pts with cardiac symptoms- reduce rate of deaths and atherosclerotic events
  4. Plavix SE NI
    GI distress, small risk of neutropenia (low WBC), prolonged bleeding

    • NI
    • assess CBC, platelet
    • assess risk for infection
    • assess drug interation- competes for metabolic pathways
    • adm with food for GI upset
    • effects peak 3-5 days
  5. Aspirin (Antiplatelet)
    • inhibits Cycoolanase and throm. A. 
    • low doses work on Cox 1 < 100mg/day
    • high doses work on Cox 2 (anti inflammatory)

    CI admin within 48hrs of stroke, after MI to prevent infarcts, prevent risk of stroke, MI, CV deaths

    • SE: GI, salycism, reyes syndrome
    • admin plavix and aspirin 3 weeks after a stroke (blood clot to the brain)- decrease thrombotic events

    • NI
    • review 
    • assess for bleeding
    • be careful with drugs that cause bleeding
    • tell pt to stop taking 1 week prior to surgery
    • adm with food
  6. Anticoagulant agents
    • interfere with clotting cascade and prolong blood clotting time
    • vary by route and MOA
    • side effects: bleeding
  7. GI bleeding
    • GI
    • stool
    • gums
    • nose bleed (epitaxis)
    • hematuria
    • poor wound healing
    • ecchymosis
  8. Anticoagulants  agents 
    Lab assessment
    when a pt is on an anticoug. u have to monitor their clotting factor

    • APTT/PTT- activated partial thormoboplanstin time 
    • involves evaluating clotting factors I, II, V, VIII, IX, X, XI, XII
    • normal APTT 30-40sec

    effective anticoag. we want above 70 sec bc we want to prevent clot. we want to form a balance of no clot and no bleeding

    assesses the instrinic system of the clotting cascade

    looks at heparin cause it works on the intrinsic system
  9. PT
    • Prothombin time
    • eval the extrinic system
    • involves factors I, II, V, VII X 
    • this is when u are giving coumadin
    • clotting factors are Vit K dependent
    • we want the PT to prolonged bc it will take longer to clot
    • 10-30 sec- u want ur PT to be 1.5-2x the control

    current utilize INR
  10. INR
    • International normalized ratio Value
    • world health organization endorses the INR
    • therapeutic range is 2-3 but will depend on the pt dx
    • if INR above 4 there is increase for bleeding 
    • standardized
  11. Heparin Sodium
    • MOA- interferes with the final step of the clotting cascade prevents extension of the clot
    • it prevents the conversion from prothrombin to thrombin, fibrition to fibrin 
    • Fibrin is what stabilzes the clot- if u dont stabilize the clot u have known (last step)
    • no effect on clots already form- prevents clot from forming and from extended
  12. Heparin low doses
    • low doses deactivate factor X, mim effect on thrombin
    • preventative dose
    • dose does not alter APTT
    • no effect on thrombin
  13. Heparin CI
    adm SC, IV

    • Sc- low dose
    • IV- preventing conversion from prothrom etc
    • use to thromembolism, prevent emboli formation with a.fib
    • prevent extension of pulmonary emboli
    • effects are indiv. what works on one pt may not work on another

    Cant give it orally cause it gets deactivated the by the gastric juices
  14. Heparin SE
    • bleeding (common site gums)
    • hypersensitivity- 
    • Heparin induce thrombocytenia (HIT)- initiate a reponse and drops platelet count
    • long term- alopecia, osteoporosis, skin necrosis
  15. Heparin NI
    • assess bleeding- gums
    • assess results- APTT/PTT
    • careful regarding dosage
    • order in units 
    • concentration and route
    • adm- sc 25 gauge, 5'8 needle, 3ml
    • 90
    • no aspiration, no rubbing
    • no sites- abdomen, leg, and arm
    • rotate site
    • avoid IM injection- risk bleed
    • avoid razor, soft tooth brushes- risk
    • low dose/sc does not effect lab values
  16. Heparin IV
    • full anticouag effects
    • assess labs APTT. PTT
    • start IV bolus followed by IV infusion
    • works immediately and done quickly
    • IV infusion/ always on a pump
    • two RN check dosage/calculation
    • do not interrupt IV heparin nothing added to the line 
    • assessment for bleeding
  17. Heparin NI
    • assess for overdose
    • antidote protamine sulfate- neutralizes the effect of heparin
    • 1mg of protamine sulfate for every 100u of heparin
    • assess se hypotension, bradycardia, flushing
    • no active bleeding
  18. Low Molecular Weight Heparin

    • deprived from heparin
    • breakdown of heparin into basic building blocks

    • enhances the bioavailibility 
    • more predictable dose response 
    • longer half life- once a day
    • bc low dose dont need to monitor level
    • fewer se
  19. Lovenox Low molecular weight heparin
    MOA- binds to antithrombin III, prevents conversion of factor X into thrombin- interupting the cascade

    • CI: prevent DVT after surgery, for pt not moving, treat ischemia after MI or angina, prevention and treatment of DVT, PE
    • sc
  20. Lovenox SE NI
    less likely to cause bleeding and HIT, more predicible, thrombocytepenia

    • NI
    • more consistent results with heparin 
    • adm deep sc injection- abdomen
    • prefilled syringe
    • calculate dosage
    • antidote- protamine sulfate
    • increase risk for paralysis for pt with epidural catheter- risk for bleeding
  21. Oral anticouglant
    Warafin (coumadin)

    • MOA: competively blocking Vit K at its sites of action, prevents the activation of factor, II, VII, IX, X
    • no effects on clots already form. just prevents clots from forming

    • CI: after therapy with heparin, takes 7-10 to start working. so while pt on heparin u will give coumadin med..since it starts days out. 
    • long
  22. oral agent
    SE: bleeding other N/V

    • NI
    • monitor PT and INR
    • max effect 3 days to get therapeutic effect
    • standardize given at 6pm (same time everyday)- allows to draw labs in the morning so md can make reccommendation
    • avoid food/diet high in Vit K
    • antidote is Vit K
    • pt teaching- skip a dose don't double dose-risk for bleeding
    • home- electric razor, soft toothbrush
    • be careful with contact sports
    • drugs interaction