Blood Thinners

Question 1

3 Types of blood thinners

Answer 1

Antiplatlets
Anticoagulants
Thrombolytics

Question 2

Antiplatelets

Answer 2

Aspirin
Clopidogrel
Lower platelet aggregation
Prevents clots
Use for post PCI
Before giving always asses:
Hgb <7 = bleed risk
Platelets less than 150,00 notify HCP
less than 50,000 very risky these meds should not decrease alt levels

Question 3

Before giving Antiplatlets

Answer 3

always asses:
Hgb <7 = bleed risk
Platelets less than 150,00 hold drug and notify HCP
less than 50,000 very risky these meds should not decrease alt levels

Question 4

Aspirin toxicity

Answer 4

Activated charcoal
Initial treatment off salicylate
Key signs of toxicity = tinnitus and hyperventilation
tachycardia and hypotension are not signs of toxicity but may indicate a bleed

Question 5

Glycoprotein (GP) receptor inhibitors

Answer 5

Abciximab
Eptifibatide
Tirofiban

mainly used after cardiac procedures watch for bleeding
1. Assess hgb and platelets
2. Assess for bleeding, red tinged urine or dark tarry stools/black bloody stools
3. Monitor groin insertion site
4. Monitor egg changes
5. No new IV or IM

Question 6

Anticoagulants

Answer 6

Heparin vs. Warfarin
Given for prevention of new clots and prevents growth of existing clots (MI, DVT)
do not dissolve clots
Blocks fibrin (forms seals on clots)

Both medications are given together for several days

Question 7

Heparin

Answer 7

Works Fast
Can only be IV or SQ
PTT: 46-70 max range antidote: protamine sulphate not associated with food
Usually given after MI or PE
SQ = enoxaparin, dalteparin = prevention of clots after surgery inject at 90 degrees, 2 inches from belly button (clarify order if H/H low or open fracture)

Question 8

PTT over 70, priority action

Answer 8

1 Stop the heparin - Notify the HCP
Prepare antidote: Protamine sulfate
Reassess labs in 1 hour

Question 9

Blood oozing at surgical incision on heparin drip

Answer 9

Stop the heparin - notify HCP
Prepare antidote protamine sulfate
reassess labs (1 hour)

Question 10

Warfarin

Answer 10

Works slowly
5 days to reach full effect, lasts longer and can bee taken longer
INR: 2-3
2.5 - 3.5 (heart valve replacements)
Antidote: vitamin K
don’t give if warfarin within therapeutic range
Not until at least 5 days of warfront when switching from IV hep
Antibiotics increase risk off bleeding by increasing INR
Life long therapy
Frequent blood tests needed

Question 11

Foods with Vitamin K

Answer 11

Liver
Green leafy vegetables (broccoli, spinach)
Key patient teaching: consistent and moderation keep K consistent
Not increased
Not decreased
Not avoided totally

Question 12

INR of 4 or 5

Answer 12

Assess for bleeding
Get vitamin K antidote ready

Question 12

Client on warfarin, which statement requires intervention

Answer 12

I will increase my intake of dark green leafy vegetables

Question 13

INR 2.0 in an ischemic CVA client

Answer 13

Give warfarin t to get up to 2.5

Question 14

Client on enoxaparin what do you report to HCP

Answer 14

H and H decreased
BP drops by 20 points
Monitor for low platelets
Not aPTT or INR

Question 15

Heparin induced thrombocytopenia

Answer 15

Plates decreased by half in 24 hours after starting heparin of any type
Very deadly
Priority: alert HCP

Question 16

Fondaparinux

Answer 16

No risk for heparin induced thrombocytopenia
May cause epidural bleeds
Do not use for at least 6 hours after surgery
No anticoagulants with spinal epidural catheter

Question 17

Factor Xa inhibitors

Answer 17

Rivaroxaban
Edoxban
Apixaban

Avoid aspirin while on this med
Avoid OCT that increase bleeding like NSAIDS and supplements
Lower risk of bleeding compared to warfarin
No need for routine clot studies
No need to avoid vitamin K

Risk for neurological impairment
Rivaroxban: teach client methods to reduce bleeding

Question 18

Other throbbing inhibitors

Answer 18

Dabigatran and Argatroban
Used to prevent clots in high risk a fib patients
Do not stop taking med for GI issues
Stop if black tarry stools
Not store in pill box, in original container
Not crushed, taken whole
Hold clopidogrel
Hold before surgery

Question 19

Thrombolytics

Answer 19

Clot busters
TPA
Ateplase
Reteplase
Streptokinase

only meds that dissolve clots
Can only be given in a 3-4.5 hour window form onset of symptoms
Big caution = massive bleed risk
No injections, no IV, no IM, no SQ, No ABG
Never through central line only through peripheral IV

Question 20

Thrombolytics Contraindications

Answer 20

Active bleeding - peptic ulcer
Uncontrolled HTN 180/110
Recent surgery within 2 weeks

Clarify prescription with provider
Accidents - recent tauma
Aneurysm - Hx of hemorrhagic CVA
AV malformation

Question 21

Patient teaching for Bleeding

Answer 21

Bleeding precautions: No active bleeds (peptic ulcers)
Avoid:
Cirrhosis
hepatitis
alcohol
NSAIDS
Tylenol overdose
Liver damage

Monitor signs of bleeding, monitor HCP immediately
Key words: black tarry stools, hematuria, Epistaxis, petechiae on chest, easy breathing

Avoid:
Vitamin E
Ginseng
Ginkgo biloba
Garlic
Omega 3
st johns wort

Avoid Trauma:
No small rugs or dim halls
No hard brushing
No flossing
No alcohol used mouth wash
No razors
No constipation = fibre and fluids
No contact sports
Medical alert bracelet

Question 22

When do you hold the heparin and contact the HCP

Answer 22

Patient has recent diagnosis of peptic ulcer
Patient has apTT of 105
Patient has black tarry stools
Patient is taking ginkgo and vitamin E

Question 23

When do you question the order of aspirin or clopidogrel?

Answer 23

Patient has 65,000 platelet
Currently taking warfarin
Regular consumption of 6 glasses off wine per night

Question 24

A patient on dabigartan fora fib which actions should the nurse initiate?

Answer 24

Report stools that are black and tarry
Teach patient to avoid clopidogrel
Teach patient to stop taking this med before surgery