anticoagulants, antiplatelets, and thrombolytic medications Flashcards
antiplatelets
alter the formation of the platelet plug
anticoagulants
interfere with clotting cascade and thrombin formation
thrombolytics
break down the thrombus by stimulating the plasmin system
anti-platelet examples
aspirin
clopidogrel
abciximad
anticoagulant examples
heparin
enoxaprin
warfarin
dabigatran
thrombolytic example
tPA
aspirin action
-suppress platelet aggregation
-primarily in arteries
aspirin indications
-primary & secondary prevention of MI
-prevention of stroke in pts with hx of TIAs
-anti-inflammatory & anti-febrile
aspirin precaution
IRREVERSIBLE ACTION
-single dose of aspirin persists fro the life of a platelet (7-10 days)
if someone taking aspirin was having an elective surgery, when would you tell them to stop taking the aspirin?
7 days prior to surgery
adverse effects of aspirin
-GI upset & bleeding
-hemorrhagic stroke
-salicylate toxicity
what does salicylate toxicity look like?
-agitation
-confusion
-tachycardia
-fever
-ringing in ears
should you recommend someone take aspirin with food?
yes
aspirin contraindications
-peptic ulcer
-thrombocytopenia
aspirin teaching
-bleeding
-GI upset
-overuse
clopidogrel indications
-reduces risk of thrombotic events in patients with CAD
-prior to or after cardiac procedures (Cath/stent)
what type of medication is clopidogrel?
anti platelet
clopidogrel adverse effects
-bleeding
-TTP (big flat bruising)
clopidogrel teaching
-monitor for GI side effects
-look for blood in stool and urine
-look for bruising
-take with or without food
what cannot be taken with clopidogrel?
PPI
What are the most effective anti platelet drugs??
-super aspirins
-Abciximab
-tirofiban
abciximab / tirofiban indications
-prevent ischemic events due to acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI)
abciximab / tirofiban adverse effects
-monitor for Brady cardia & hypotension
-bleeding
what do anticoagulants do?
-prevent blood clots from forming or extending
-interfere with the clotting cascade & thrombin formation
do anticoagulants break down existing clots?
no
heparin method od action
activates antithrombin thus indirectly inactivating thrombin & factor Xa which inhibits fibrin formation
heparin indication
-treat PE, DVT, stroke, when prompt anticoagulant activity is needed
-low dose for prophylaxis for surgery
-treatment of DIC
heparin contraindications
-thrombocytopenia
-Pts with high risk of bleeding (peptic ulcer disease, severe hypertension)
-post-op surgeries on the brain, eye, or spinal cord, lumbar puncture
people with what type of chronic illnesses should not take heparin?
-peptic ulcer disease
-severe hypertension
people with what type of surgery should not take heparin?
-eye
-brain
-spinal cord
-lumbar puncture
where would you administer a heparin injection?
SQ
2 inches below umbilicus
can heparin be a drip?
yes
monitoring for heparin
-frequent monitoring and titration of drip rate based upon aPTT
what are therapeutic aPTT values for someone on heparin?
-1.5-2 times the control
heparin most common adverse effects
-hemorrhage
-heparin-induced thrombocytopenia
-hypersensitivity reaction
heparin antidote
protamine sulfate
heparin teaching
-avoid aspirin
-report bleeding, bruising, dark tray stool
enoxaparin mechanism of action
-activates antithrombin thus indirectly inactivating factor Xa which inhibits fibrin formation
enoxaparin indications
-prevent DVT post-op
-treat DVT & PE
-prevents complications of MI
enoxaparin contraindications
-thrombocytopenia
-pts with a high risk of bleeding (peptic ulcer disease, severe hypertension
-post-op surgeries on brain, spinal cord, eye or lumbar puncture
where do you give enoxaparin injections?
SQ at anterior or posterolateral sites
monitoring for enoxaparin
-predictable pharm-kinetics: does not require PTT monitoring
-weight based
-monitor CBC
adverse effects of enoxaparin
bleeding
antidote for enoxaparin
protamine sulfate
warfarin mechanism of action
antagonizes vitamin K which prevents formation of coagulation factors
indications for warfarin
-prevent DVT & PE
-prevent thrombosis in fib or prosthetic heart valve
-reduce risk for recurrent TIA/CVA or MI
warfarin contraindications
-pts with high risk of bleeding, post-op brain/eye/spinal cord surgery
-liver disorders & alcohol use disorders
warfarin most common side effect
bleeding
warfarin assessment
MONITOR FOR BLEEDING
-watch INR
-PT should be 1.5-2 times patient’s baseline value
-INR level is 1.1 or lower, desired therapeutic range of 2-3
warfarin antidote
Vitamin K
general teaching points for heparin, enoxaparin, & warfarin
-avoid aspirin
-electric razors & soft toothbrushes
-report bruising, dark tarry stools, fatigue, dizziness, palpations
-stay away from foods high in vitamin K
foods high in vitamin K
spinach, green leafy veggies, broccoli, kale
indication for thrombin inhibitors
-DVT
-PE
-CVA with afib
dabigatran antidote
Praxbind
direct thrombin inhibitors administration
-oral
-short acting
direct thrombin inhibitors contraindications
-pts with high risk of bleeding or active bleeding
-liver disorders & alcohol use disorders (higher risk for bleeding)
direct thrombin inhibitors precautions
-aspirin
-NSAIDS
-other anticoagulants
-hepatic of renal impairment
-pregnancy category C
rivaroxavan/apiaxban antagonist
andexanet alfa
why would an antidote to a direct thrombin inhibitor be given?
-in the event of an emergency surgery
-urgent procedure
-life-threatening or uncontrolled bleeding
risks of dabigatran
-surgery or dental work bleeding concerns
-spinal or epidural blood clots leading to paralysis
biggest concern about dabigatran
no reliable lab test to identify overdose
teaching for dabigatran
-monitor for bleeding signs
-soft tooth brush, electric razor
-avoid over the counter meds like feverfew, garlic, ginger, gingko biloba, saw palmetto
alteplASE action
-breaks down formed clots
-can interfere with new clot formation
alteplASE indications
-evolving MR or CVA
-massive PE
-extensive DVT
-arterial thrombosis
-open clotted paths
alteplASE administration
-IV, time is priority
alteplASE contraindications
-intracranial hemorrhage
-active internal bleeding
-ischemic stroke within past 3 months
-cautious with uncontrolled hypertension
alteplASE adverse effects
-bleeding
-hypotension
-fever
management of bleeding with thrombolytics (alteplASE)
-use whole blood, FFP if bleeding is excessive
what to use if blood products don’t work to fix bleeding with thrombolytics?
aminocoproic
management of bleeding
-minimize physical manipulations of patient
-avoid sub Q or Im injections
-minimize invasive proceures
-manual BP no automated cuff
-minimize concurrent use of anticoagulants and anti-platelet drugs
-monitor aPTT, INR
-monitor CDC: H&H
-no foley Cath
complementary therapies that suppress platelet aggregation
-feverfew
-ginger root
-glucosamine
-garlic
-ginko biloba
