Anticoagulants

Question 1

DABIGATRAN ETEXILATE

Pradaxa

Answer 1

◾ Used for prevention of stroke in patients with nonvalvular atrial
fibrillation
◾ Keep in original packaging (blister pack or manufacturer bottle) until
administered
◾ PO: may take without regard to meals
◾ Do not crush or chew capsules
◾ Closely monitor for signs of bleeding
◾ Increased risk of bleeding when combined with aspirin, other
antiplatelets, or anticoagulants
◾ Reduced dose required in renally impaired patients
◾ Stop med 24 hours before surgery
◾ Rx; Preg Cat C

Side Effects:
Dyspepsia, Abdominal discomfort, Epigastric pain
GI hemorrhage, Bleeding, Hematoma, Anemia

Question 2

ENOXAPARIN

Lovenox

Answer 2

◾ Anticoagulation during acute coronary syndromes, prophylaxis and
treatment of venous thromboembolism
◾ Injection: subQ; can be given IV during cardiac procedures
◾ Do not use in patients with a history of heparin-induced
thrombocytopenia
◾ Use with caution in patients with impaired renal function or morbid
obesity
◾ Monitor closely for signs of bleeding or excessive bruising
◾ Stop med 12–24 hours before surgery
◾ Rx; Preg Cat B

Side Effects: 
Bleeding
Bruising
Injection site hematoma
Injection site ecchymosis
Hematuria
Increase in AST/ALT

Question 3

HEPARIN

Answer 3

◾ Prophylaxis and treatment of thromboembolic disorders in very low doses
(10–100 units) to maintain patency of IV catheters (heparin flush)
◾ Therapeutic PTT @ 1.5–2.5 times the control without signs of hemorrhage
◾ IV: peak 5 minutes, duration 2–6 hours (give over 1 minute)
◾ Injection: give deep subQ; never IM (danger of hematoma), onset
20–60minutes, duration 8–12 hours
◾ Antidote: protamine sulfate within 30 minutes
◾ Signs of hemorrhage: bleeding gums, epistaxis (nosebleed), unusual
bleeding, black or tarry stools, hematuria, fall in hematocrit or blood
pressure, guaiac-positive stools
◾ Avoid ASA-containing products and NSAIDs
◾ Wear medical information tag
◾ Abrupt withdrawal may precipitate increased coagulability
◾ Rx; Preg Cat C

Side Effects:
Can produce hemorrhage from 
any body site (10%)
Tissue irritation, pain at injection site
Anemia, Thrombocytopenia

Question 4

RIVAROXABAN

Xarelto

Answer 4

◾ Stroke prevention in nonvalvular atrial fibrillation, prevention and
treatment of venous thromboembolism
◾ Dose reduction required in renal impairment
◾ PO: give doses >15 mg with food; lower doses may be given without
regard to food
◾ Stop med 24 hours before surgery
◾ Monitor closely for signs of bleeding or excessive bruising
◾ Rx; Preg Cat C

Side Effects:
Bleeding, Bruising, Epistaxis, Peripheral edema
Nausea, Dyspepsia, Hematoma
Anemia, Thrombocytopenia

Question 5

WARFARIN

Coumadin, Jantoven

Answer 5

◾ Management of pulmonary emboli, deep vein thrombosis, MI, atrial
dysrhythmias, postcardiac valve replacement
◾ Therapeutic PT @ 1.5–2.5 times the control, INR @ 2.0–3.0
◾ Onset: 12–24 hours, peak 1.5 to 3 days; duration 3 to 5 days
◾ Avoid foods high in vitamin K: many green leafy vegetables
◾ Do not interchange brands; potencies may not be equivalent
◾ Do not take any drug or herb without physician approval—may
changeeffect
◾ Avoid ASA-containing products and NSAIDs
◾ Oral anticoagulants may cause red-orange discoloration of alkaline
urine, interfering with some lab tests
◾ Wear medical information tag
◾ Rx; Preg Cat X

Side Effects:
Hemorrhage, Diarrhea, Rash, Fever
Angina syndrome, Syncope
Anemia, Dermatitis, Jaundice, Elevated liver 
enzymes, Anaphylactic