Anticoagulants, Antiplatelets, Thrombolytics- Swingler
What are examples of antiplatelets?
Aspirin, clopidogrel, cilostazol
What is the anecdote for heparin?
Protamine Sulfate (slows down anticoagulant cascade)
What should be assessed when a patient is starting dabigatran?
Renal function
Where must enoxaparin sodium be administered? The _____ ________should be given.
The abdomen; air bubble
How do anticoagulants work?
They work against the clotting cascade
Examples of thrombolytics?
alteplase, streptokinase
Works by preventing the formation of a venous clot
anticoagulant
This "blood thinner" is used prophylactically
anticoagulants; i.e. heparin, enoxaparin sodium
How does aspirin work?
inhibits an enzyme which is needed for platelets to become "activated".
Why is warfarin a risk for toxicity?
It has a long half-life
What patients is aspirin used for?
It is commonly administered for patients with a family history of stroke or MI. It is considered the first line emergency drug when a patient is experiencing acute coronary syndromes including MI
Why is heparin given subQ or IV?
It is poorly absorbed
How must aspiring be taken?
It must be chewed
Does enoxaparin sodium have a longer or shorter half-life than heparin?
Longer
Why would enoxaparin sodium be preferred over heparin?
Lower risk of bleeding
Thrombolytics must be given within a certain time frame. When should it be started for an MI? A thrombolytic stroke?
MI- within 4 hours Thrombolytic stroke- within 3 hours
Do rivarozaban and apixaban require lab monitoring?
No
Does enoxaparin sodium require any labs to be monitored?
No.
How can vitamin K be given? How quickly does it work?
PO or IV. It does not work quickly.
How can anticoagulants be administered?
PO, SubQ, IV
Which lab test needs monitored for a patient taking warfarin? How often?
PT/INR; weekly
Which labs need monitored when a person is taking heparin?
PTT/APTT
Who takes anticoagulants such as heparin and enoxaparin sodium?
Patients at high risk for clot formation: DVT, PE, MI, CVA, Stroke, Heart, Valve Replacement and clotting that occurs secondary to AFib
What patients is enoxaparin sodium used for?
Patients with decreased mobility
When should a patient stop taking aspirin or clopidogrel if they have a scheduled surgery?
1 week prior to surgery
What is the therapeutic range of warfarin?
2-3
What is a prophylactic dose of enoxparin sodium?
30-40 mg/day subQ
What dose of enoxaparin is a patient on if they are being treated for a clot?
80-100 mg
What are usual dosage guidelines for aspirin?
81-325 mg/day
What does <2 mean in regards to warfarin? >3?
<2= risk for clotting >3= risk for bleeding If <2, dose needs increased. If >3, dose needs decreased
What is the biggest nursing priority intervention when dealing with anticoagulants, antiplatelets and thrombolytics?
Being able to interpret lab values
What is a major adverse effect to look for after administering a thrombolytic?
Change in LOC, bloody stool (thrombolytics break up a clot anywhere in the body)
What is an example of a low molecular weight heparin?
Enoxaparin sodium
If a patient is hemorrhaging from warfarin, vitamin K takes too long to work. What can be given to the patient?
FFP (fresh frozen plasma)
Why is fresh frozen plasma given for hemorrhaging?
FFP contains clotting factors only
What patients are antiplatelets used for?
Primarily used for prophylaxis and patients with high risk for TIA, Stroke, and MI
Why might a CBC be ordered when a patient is taking heparin?
Heparin can decrease platelet counts
How do thrombolytics work?
Induces fibrinolysis (breaks down the fibrin that is used to solidify the clot; busts up the clot)
How do oral anticoagulants work?
Inhibit hepatic synthesis of vitamin K; the clot is prevented because without vitamin K, the clotting factors are inhibited; they also prolong the time it takes for blood to clot
What is the anecdote to warfarin?
Vitamin K
How do antiplatelets work?
Work by preventing platelet aggregation in arteries
How does clopidogrel work?
may be used by itself or in conjunction with Aspirin. It works a little different than aspirin but has the same effect
How does Heparin work?
speeds up the anticoagulant cascade; inhibits the action of thrombin which in turn inhibits the conversion of fibrinogen to fibrin, therefore clot is prevented
What are contraindications for aspirin?
true drug allergy, cerebral hemorrhage, and recent GI bleed; patients should not be taking this for pain and/or fever
What are examples of oral anticoagulants?
warfarin, rivaroxaban, apixaban, dabigatran
