Anticoagulants Flashcards
Pt time
12-15 seconds, prothrombin time
INR
0.8-1.2 person not receiving anticoagulants
INR for PE, DVT, A-Fib
2.0-3.0
INR for mechanical valves
3.0-4.0
PTT
25-35 seconds
How is heparin given?
With a 5/8in. needle 25 to 28 g, at a 90 degree angle
What is the antidote to heparin?
protamine sulfate
What is the antidote to lovenox?
protamine sulfate
What is the antidote for warfarin?
vitamin k
warfarin dietary guidelines
avoid alcohol, leafy greens eat consistently
Pradaxa antidote
No specific antidote, dialysis may remove
Do NOT administer heparin
IM
What intrinsic factor does coumadin act on?
IX
What intrinsic factors does heparin act on?
X & Xa
What factor does Coumadin act on?
X
What factor does Eliquis & Xarelto act on?
Xa
What factor does Pradaxa act on?
Thrombin
Clotting Sequence
X-Xa-Prothrombin-Thrombin-Fibrinogen-Fibrin
Process of Hemostasis
Injury to vessel, vessel spasm, formation of platelet plug, formation of fibrin clot, clot retraction, clot dissolution
What are indications for Anticoagulant therapy?
DVT, PE, MI, ischemic CVA, Chronic Atrial Fibrillation, Valve Replacement, DVT prophylaxix
Routes of Anticoagulants
Oral, IV, SQ
Route of Thrombolytics
IV
How does warfarin work?
Inhibits vitamin K dependent factors
Indications for warfarin
a-fib, mechanical valve replacement, history of PE, VTE
What do you do if you miss a dose of warfarin?
Take as soon as possible on same day, but do not double the next dose
Notify physician when on warfarin if..
Serious fall or injury, red, dark brown urine or black, tarry stools
What is Pradaxa?
Direct thrombin inhibitor
How often is Pradaxa taken?
Twice a day
How quickly does Pradaxa reach therapeutic levels?
30 min to 2 hours after PO administration
What are indications for Pradaxa?
Afib not caused by heart valve problem (75-150mg 2X/day)
VTE prevention after hip/knee replacement (150-220mg 1X/day)
Dietary restrictions Pradaxa?
No
What does Pradaxa interact with?
Rifampin decreases effectiveness of Pradaxa
Does Pradaxa require regular monitoring of blood levels?
No
How is Xarelto taken?
Orally 1X/day
Antidote for Xarelto
None
Xarelto indications
A-fib not caused by heart valve problem (20 mg/evening meal), VTE prevention after hip/knee surgery (10 mg 1X day with or without food)
What meds increase bleeding with Xarelto/
Aspirin, Nsaids, warfarin, heparin, plavix, effient, brilinta
Eliquis-when taken? What for?
2X/day, 5 mg, for A-fib not caused by heart problem
Teaching r/t anticoagulants
soft bristle brush, waxed floss, electric razor, medic alert bracelet, inform HCPs of use
What does Heparin do?
- Prevents the activation of clotting factors of X and Xa
2. It inhibits the action of thrombin in forming fibrin threads
Heparin indications
prevention and treatment of VTE (venous thromboembolus)
treatment of VTE, PE, CVA or TIA
How is heparin dosed?
5,000-10,000 Units q 8-12 h,
IV: 4,000-5,000 Units initially & then continuous infusion of 20,000-40,000/24 h
IV patency: 10-100 units
What do you monitor prior to and during administration heparin
PTT
When injecting heparin remember..
Do not aspirate, do not massage site, ensure that injection is given in fatty area of abdomen at least 2 in away from the umbilicus
When giving heparin monitor..
for bleeding gums, hematuria, nosebleeds, bloody sputum, and petechiae
Protamine Sulfate each mg neutralizes how much heparin?
1 mg protamine sulfate neutralizes 100 units heparin
No more than this much Protamine sulfate should be administered in any 10 min period
no more than 50 mg in any 10 min period or 100 mg in 2 hour period
Why are LMWH used
action more predictable, less monitoring, can be used outpt, lower incidence of HIT
Platelet Aggregate inhibitors or Antiplatelets ex
ASA, Plavix, Brilinta, Aggrenox,Persantine, effient
Indications for antiplatelets
CAD/ACS, Hx of MI, Post cardiac surgery (valve replacements & CABG), CVA, TIA, PVD, PAD
S/E antiplatelets
headache, dyspnea, nausea
Purpose of thrombolytics
Dissolve thrombi and restore blood flow to heart or brain during CVA or AMI
When to initiate thrombolytics
Within 3 hrs
Most common thrombolytic
tPA (also Streptokinase, Urokinase, Reteplase
CONTRAindications thrombolytics
recent head injury, bleeding probs, bleeding ulcer, pregnancy, surgery, trauma, UNcontrolled high blood pressure
Nursing interventions thrombolytics
Hold pressure at site when drawing blood, assess for bleeding & hematomas at puncture sites, avoid IM injections
