Module 3A - blood and coagulation meds

anticoagulants

• heparin, enoxaparin

• don’t break up existing clots

• prevent new blood clots from forming

• keep clots from getting bigger

heparin indications

• high alert med

• for active thromboembolism

heparin labs

• aPTT - normal 30-40 seconds, normal on treatment 60-80 seconds or 1.5-2 times baseline

• Platelets - hold if less than 100,000

• H/H

heparin routes

IV and subQ only

heparin antidote

protamine sulfate

enoxaparin indication

• primarily preventative for post surgery/bed bound pts

• low molecular weight heparin aka less potent

enoxaparin route

subQ, always admin 2in away from umbilicus, don’t aspirate or rub

enoxaparin labs

platelets - hold if <100,000

Vitamin K inhibitor

• prevention of thrombotic events

• warfarin

warfarin indications

• prevent MI

• prevent clots caused by afib

• prevent stroke

• prevent DVT/PE

warfarin route

PO → long half-life of 3-5 days

warfarin labs

• PT - normal 11-12.5 seconds, therapeutic 1.5-2 times baseline (around 18-24)

• INR - normal 0.8-1.1, therapeutic 2-3, 3-4 for mechanical heart valves

• AST/ALT

warfarin antidote

vitamin K

warfarin contraindications

• pregnancy category X

• alcohol use/liver failure

anti-platelet agents

• prevents platelets from clumping together (aggregation)

• alter bleeding times

• effects last lifetime of platelet (7 days)

aspirin contraindications

children and adolescents with fever or recent chickenpox due go risk of Reye’s syndrome

aspirin dose

• 81mg for prevention of stroke, MI, reinfarction

• 325mg for initial acute episode of MI

clopidogrel labs

platelets

clopidogrel education

• monitor for s/s of bleeding r/t thrombocytopenia

• don’t take with other meds that enhance bleeding

clopidogrel therapeutic effectiveness

• absence of arterial thrombosis

• adequate tissue perfusion and blood flow without occurrence of abnormal bleeding

Thrombolytics

• alteplase

• dissolve clots that are already formed → clot buster

• serious serious risk of bleeding

• must have risk vs. benefit conversation before administering

• another nurse must verify dose and rate

alteplase indications

• symptomatic MI

• ischemic stroke

• massive PE

  * must be give within 3 hr of onset of symptoms

alteplase antidote

IV aminocaproic acid → reverses fibrinolysis

alteplase therapeutic effectiveness

• thrombus lysis

• restoration of circulation

• relief of chest pain, reduction in ST segment injury patter as shown on ECG 60-90 minutes after start of therapy

alteplase adverse effects

• s/s of bleeding

  • tachycardia

  • hypotension

  • excessive bruising

  • hematomas

  • petechiae

  • vomiting blood

  • black, tarry stools

  • nose bleeds

  • bleeding gums

  • shock

alteplase labs

CBC

alteplase pt education

• monitor for bleeding

• use electric razors and soft tooth brushes

• avoid OTC NSAIDs

growth factors

epoetin alfa → increases production of red blood cells

epoetin alfa routes

subQ or IV

epoetin alfa adverse effects

• hypertension secondary to elevated hematocrit levels

• risk for thrombotic event especially if hbg >11

epoetin alfa contraindications

• pt’s with uncontrolled hypertension

• pregnancy category C

• some cancers

epoetin alfa effectiveness

• hgb 10-11 g/dL

• maximum hct of 33%