Anticoagulants

Question 1

uses for anticoagulants

Answer 1

prevention/tx MI or stroke
prevention/tx of DVT
atrial fibrillation
artificial heart valve

Question 2

mechanism of anticoagulants

Answer 2

clot formation is complicated; may inhibit:

platelet aggregation - aspirin, clopidogrel
clot cascade - heparin, enoxaparin, warfarin

Question 3

clot formation

Answer 3

inactivated platelet–>activated–>platelet aggregation–>clot cascade provides fibrin clots

Question 4

issues w/anticoagulants in general

Answer 4

bleeding:
increased HR d/t shock
decreased BP d/t thin blood
ecchymosis - Cullen's sign, Turner's sign
coffee-ground emesis
black stool "melena"

advise pt to use soft bristled toothbrush, electric razor

Question 5

heparin

Answer 5

rapid acting, short half-life
requires close monitoring of PTT:
nml = 40sec, therapeutic = 60-80sec
watch sx of bleeding: increased HR, decreased BP, ecchymosis, coffee-ground emesis, melena

antidote: protamine
avoid: herbals “g” (garlic, genko biloba, ginger, glucosamine)

Question 6

enoxaparin

Answer 6

rapid acting, longer half-life
less monitoring needed
must inject in subcutaneous “love handles”, don’t twist cap/aspirate, leave air bubble in syringe
must take at same time daily

antidote: protamine
avoid: herbals “g” (garlic, genko biloba, ginger, glucosamine)

Question 7

warfarin

Answer 7

5 day delayed onset
must monitor PT/INR:
nml = 1, therapeutic = 2-3, mechanical heart valves = 3-4.5
must maintain vitamin K levels (leafy greens, mayo)

antidote: vitamin K
avoid: herbals “g” (garlic, genko biloba, ginger, glucosamine)

Question 8

alteplase

Answer 8

anticoagulant which dissolves clots
used for MI/stroke/central line clot
huge risk of bleeding