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  1. Various agents
    • -Anticoagulans- Inhibit the action or formation of clotting factors, prevent clot formation
    • -Antiplatelet drugs-Inhibit platelet aggregation, prevent platelet plugs
    • -Thrombolytic drugs-Lyse (break down) existing clots.
  2. Coagulation Modifiers

    • Type

    • Drug

    • Class
    • Agent

    • Prevent

    • Clot Formation
    • Inhibit

    • clotting factors
    • Inhibit

    • platelet binding
    • Anticoagulant

    • Antiplatelet

    • heparin,

    • Lovenox®,
    • Fragmin®,
    • Coumadin®
    • aspirin,

    • Plavix®, Persantine®, Trental®, Pletal® Reopro®, Integrilin®, Aggrestat®,
    • Promote

    • Clot Breakage
    • Lyse

    • the clot
    • Thrombolytic

    • Alteplase®, Retaplase®, TNKase®

    • Reversal

    • Agents
    • Heparin

    • Warfarin

    • Protamine

    • sulfate
    • Vitamin

    • K
  3. Anticoagulants
    • -Have no direct effect on a blood clot that is already formed
    • -Used prophylactically to prevent-Clot formation (thrombus), An embolus (dislodged clot)
  4. Coagulation System
    • -"Cascade"
    • -Each activated factor serves as a catalyst that smplifies the next reaction
    • -Result is fibrin, a clot-forming substance
    • Intrinsic pathway and extrinsic pathway
  5. Extrinsic Pathway
    Image Upload 1
  6. Intrinsic Pathway
    Image Upload 2
  7. The fribrinolytic system
    Image Upload 3
  8. Anticoagulants: Mechanism of action
    • -Vary, depending on agent
    • -Work on different points of the clotting cascade
    • -Do not lyse existing clotes
    • -heparin- Turns off coagulation pathway and prevents clot formatin
    • -warfarin
    • -All ultimately prevent clot formation
    • -heparin
    • -Low-molecular-weight heparins
    • -warfarin
  9. Anticoagulants
    -Prevention of clot formation also prevents: Stroke, myocardial infarction, deep vein thrombosis (DVT), pulmonary embolism (PE)
  10. Anticoagulants: Indications
    • -Used to prevent clot formation in certain settings
    • -Myocardial infarction, unstable angina, atrial fibrilation, indwelling devices, such as mechanical heart valves, Major orthopedic surgery
  11. Anticoagulants: Side/Adverse effects
    • -Bleeding-risk increases with increased dosages
    • -May also cause: Nausea, vomiting,abdominal cramps, thrombocytopenia, others
  12. Anticoagulants
    • -heparin- Monitored by activated partial thromboplastin times (APTTS), Parenteral, Short half life (1 to 2 hrs), Effects reversed by protamine sulfate
    • -Low-molecular-weight heparins- enoxaparin (Lovenox) and dalteparin (Fragmin), more predictable anticoagulant response, do not require frequent laboratry monitoring, given subcutaneously
    • -warfarin sodium (Coumadin)- given orally only, monitored by prothrobmbin time (PT) or (INR), Vitamin K can be given if toxicity occurs
  13. Antiplatelet Agents
    • -Prevent platelet adhesion-aspirin,dipyridamole (Persantine), Aggrenox-Inhibit cyclooxygenase pathway
    • -Pentoxifylline (Tental)-Highers erythrocyte flexibility, lowers fibrinogen
    • -clodidogrel (Plavix) and ticlopidine (Pletal)-ADP inhibitors
  14. Relationship between platelets and clotting cascade
    Image Upload 4
  15. Cyclooxygenase pathway
    Image Upload 5
  16. Antiplatelet Agents: Indications
    • -antithrombotic effects-Reduce risk of fatal and nonfatal strokes
    • -Side effects/adverse effects- Vary according to agent
  17. Thrombolytic Agents
    • -Agents that break down, or lyse, preformed clots
    • -Older agents-streptokinase and urokinase
    • -Newer agents- Tissue plasinogen activator (t-PA)
    • -steptokinase (Streptase) D/C
    • -altepase (t-PA, Activase)
    • -reteplase (Retavase)
    • tenecteplase (TNKase)
  18. Thrombolytic Agents: Mechanism of Action
    • -Activate the fibrinolytic system to break down the clot in the blood vessel quickly
    • -Activate plasminogen and convert it to plasmin, which can digest fibrin
    • -Reestablishes blood flow to the heart muscle via coronary arteries, preventing tissue destruction
  19. Thrombolytic Agents: Indications
    • -Acute MI
    • -Arterial thrombosis
    • -DVT
    • -Occlusion of shunts or catheters
    • -Pulmonary embolus
    • -Ischemic stroke
  20. Thrombolytic Agents: side effects/Adverse effects
    • -Bleeding- internal,intracranial, superficial
    • -Other effects- Nausea, vomiting, hypotension, anaphylactoid reactions
    • -Dysrhythmias
  21. Nursing Implications
    • -Assess: patient history, medication history, allergies
    • -Contraindications
    • -Baseline vital signs, laboratory values
    • -Potential drug interactions
    • -History of abnormal bleeding conditions
  22. Heparin: Nursing Implications
    • -Doses usually double checked with another nurse
    • -Ensure that SC doses are given SC, not IM
    • -SC doses should be given in areas of deep subcutaneous fat, and sites rotated
    • -Do not give SC doses within 2 inches of : the umbilicus, abdominal incisions, or unhealed wounds
    • -Do not asperate SC injections (may cause hematoma formation)
    • -Do not massage SC injection sites
    • -IV doses may be given by bolus or IV infusion
    • -Anticoagulant effects seen immediately
    • -Laboratory values are done daily to monitor coagulation effects (APTT)
    • -Protamine sulfate can be given as an antidote in case of excessive anticoagulation
  23. LWMHs: Nursing Implications
    • -Given subcutaneously in the abdomen
    • -Rotate injection sites
  24. Anticoagulants: Patient Education
    • -Education should include: Imprtance of regular lab testing, signs of abnormal bleeding, measures to prevent bruising, bleeding, or tissue injury
    • -Wearing a medical alert bracelet
    • -Avoiding foods high in vitamin K (tomatoes,dark lefy green vegetables, bananas, fish)
    • -Consulting physician before taking other meds or OTC products, including herbals
  25. Antiplatelete Drugs: Nursing implications
    • -Concerns and teaching tips same as for anticoagulants
    • -Dipyridamole should be taken on an empty stomach
    • -Nicotine causes vasoconstriction, which alters the effectiveness of antiplatelete agents
    • -Drug-drug interactions
    • -Adverse reactions to report
    • Monitoring for abdominal bleeding
  26. Thrombolytic Agents: Nusing Implications
    • -Follow strict manufacturer's guidelines for preparation and administration
    • -Monitor IV sites for bleeding,redness,pain
    • -Monitor for bleeding from gums, mucous membranes, nose
    • -Observe for sign of internal bleeding ( decreased BP, reslessness, increased pulse)
  27. Coagulation Modifier Agents: Nursing Implications
    • -Monitor for therapeutic effects
    • -Monitor for signs of excessive bleeding- Bleeding gums while brushing teeth, unexplained nosebleeds, heavier menstrual bleeding, bloody or tarry stools, bloody urine or sputum, abdominal pain, vomiting blood
    • -Monitoring for adverse effects- increased BP,headache, hematoma formation, hemorrhage, shortness of breath, chills, fever
Card Set
Coagulation Modifier Agents
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