Exam 3 Study Guide - Anticoagulants

What drugs are used to anticoagulate a patient?

-Heparin; unfractionated

-Low Molecular Weight Heparin

-Warfarin (Coumadin)

-Rivaroxaban (Xarelto)

-Apixaban (Eliquis)

How do anticoagulants help a patient?

The prevent the formation of a clot

What populations of patients will receive an anticoagulation drug?

Used when there is a high likelihood of clots forming from A-fib, Indwelling devices, or DVT

What are contraindicatins of anticoagulation drugs?

Acute bleeding, risk for bleeding, warfarin and pregnancy, and indwelling epidural catheter

What are adverse effects of anticoagulation drugs?

Bleeding and heparin induced thrombocytopenia

What anticoagulant should not be used in pregnant women?

Warfarin since it is a teratogen

What is heparin induced thrombocytopenia (HIT) and why is it imporant to know about?

It is a rare, potentially fatal immune mediated adverse drug reaction to heparin that causes platelet activation and clots forming - watch platlet counts

What are signs and symptoms that a patient is bleeding internally?

Edema, hypotension, dizziness, acute visual problems, bruising, shortness of breath, pain, melena

What should you do if a patient has significant bleeding and is one an anticoagulant?

Stop using anticoagulant, transfuse clotting factors or plasma, use antidote aligned with each anticoagnulant:

-Heparin & Enoxaparin: Protamine Sulfate

-Warfarin: Vitamin K

-Rivaroxaban & Apixaban: Andexanet Alpha

What lab do you monitor for heparin therapy?

aPTT

What are special considerations the nurse must think about if a patient is getting IV heparin?

-IV does is based on weight

-Loading dose then maintenance

-Monitor aPTT frequently

How is Enoxaparin helpful to patients?

Comes in pre-filled syringes so it is easier to administer and take at home

What are important eduational points to provide to a patient who will take enoxaparin at home?

-Don’t expell the air bubble within the syringe

-Don’t combine with other anticoagulants

-Give in your abdomen and clean the area with alcohol before administering

Where will prophylactic heparin be injected in the body?

SubQ in the abdomen or tricep

What class of oral anticoagulants do not require lab monitoring?

NOACs (Non-Vitamin K Antagonist, Oral, Anti, Coagulants)

What safety warnings should the nurse provide to patients taking anitcoagulants?

-Be careful of injury

-Take these at the same time each day

-If bleeding does not stop, call 911 or come to the ER

What labs will be monitored in patients taking Warfarin?

PT/INR

Why would a patient be on both Warfarin and heparin?

A patient may need a dose of heparin when starting warfarin as the therapeutic effect has a time delay compared to warfarin

Why should you educate patients on Warfarin about foods high in Vitamin K?

Vitamin K is the antidote for Warfarin so if you increase your diet in Vitamin K, Warfarin may no longer be as effective

What are some herbs that can increase bleeding in patients taking anticoagnulants?

Garlic, Ginger, Ginkgo, St. John’s wort

What are 3 antiplatelet drugs?

-Aspirin

-Clopidogrel (Plavix)

-Ticagrelor (Brilinta)

What patient populations should not take an antiplatelet drug?

-Thrombocytopenia

-Active Bleeding

-GI Ulcer

-Vitamin K deficiency

What does of ASA is commonly prescribed for prevention of clots?

81mg

What labs should be monitored when taking and anti-platelet drug?

H&H

How are thrombolytic drugs different from anticoagulant and antiplatelet drugs?

Thrombolytic drugs are drugs that treat an acute problem (clot) while the others are preventative drugs

When is it appropriate to give a patient a throbolytic medciation?

When they have an active clot

What are the three Thrombolytic drugs?

-Alteplase (Activase)

-Streprokinase

-Tissue Plasminogen Activator (TPA)

What is an important nursing consideration of Alteplase (Activase)?

Must be given within 3 hours of symptom onsets

What labs are monitored for anticoagulation therapy?

-aPTT (how long till blood clots)

-PT/INR (time for blood to clot in a sample)

-Platelets

-H&H (Hemoglobin & Hematocrit)