Anticoagulants (CH 40)
Pradaxa (dabigatran) has 5 major advantages over Warfarin:
-Rapid onset -No need to monitor anticoagulation -Few drug-food interactions -Lower risk of major bleeding -Since responses are predictable, the same dose can be used for all patients, regardless of age or weight.
Anticoagulant: Patient Education
-Importance of regular lab testing -Signs of abnormal bleeding -Bleeding Precautions -Use Electric Razor -No Aspirin -Small gauge needles -Decrease needle sticks -Protect from injury Wearing a medical alert bracelet Avoiding foods high in vitamin K -Tomatoes, dark leafy green vegetables -Consulting physician before taking other meds or -- OTC products, including herbals
PLAVIX NEED TO KNOW
-PO medication -Once per day dosing -THERE IS NO ANTIDOTE -GIVE PLATELETS
ASPIRIN NEED TO KNOW
-PO medication -Once per day dosing -Take with food -THERE IS NO ANTIDOTE -SUPPORTIVE THERAPY ONLY
COUMADIN NEED TO KNOW
-PO medication -Requires frequent lab draws -Dietary intake of leafy greens (Vit K) must be consistent -Dose is adjusted based on INR ** -THERAPEUTIC RANGE 2.0-3.0 --Higher with a mechanical heart valve Reversal agents: Vitamin K FFP (clotting factors)
AGGRENOX NEED TO KNOW
Aggrenox is a combo drug of aspirin AND dipyridamole (which prevents platelets from clumping, much like Plavix). It is used to reduce the risk of stroke in patients who are at risk. One of the biggest drawbacks to this med is that it can cause pretty unpleasant headaches in some people as therapy is initiated. -PO medication -Twice per day dosing -Combo of aspirin and a platelet inhibitor (Persantin) -THERE IS NO ANTIDOTE Pregnancy category: D PB: 91%-99%; t½: Dipyridamole 12 h, ASA 15-20 min
Antiplatelet Drugs Dosing & Uses: -- Cangrelor (Keangreal)
A: IV: Initially 30 mcg/kg bolus prior to PCI, follow immediately with infusion of 4 mcg/kg/min for at least 2 h or duration of PCI, whichever is longer: A new, nonthienopyridine antiplatelet for prevention of thrombosis in PCI and MI. May cause bleeding. Pregnancy category: C ∗ ; PB: 97%-98%; t½: 3-6 min
Antiplatelet Drugs Dosing & Uses: -- Vorapaxar (Zontivity)
A: PO: 2.08 mg/d in combination with ASA and/or clopidogrel; max: 2.08 mg/d :A new protease-activated receptor-1 antagonist for prevention of thrombosis, MI, PAD, and stroke. May cause bleeding and anemia. Pregnancy category: B ∗ ; PB: 99%; t½: 5-13 d
Antiplatelet Drugs Dosing & Uses: -- Aspirin (ASA) -Thromboembolus prophylaxis:
A: PO: 75-100 mg/d, Stroke prophylaxis: A: PO: 50-325 mg/d MI prophylaxis: A: PO: 75-162 mg/d; TDM: Salicylate toxicity is >300 mcg/mL For prevention and treatment of stroke, prophylaxis of MI, and thromboembolism. May cause bleeding, GI distress, and Reye syndrome. Pregnancy category: UK ∗ PB: 90%-95%; t½: 15-20 min
Antiplatelet Drugs Dosing & Uses: -- Ticagrelor (Ticlid)
A: PO: Loading dose: 180 mg; maint: 90 mg bid with ASA 75-100 mg/d; max: 180 mg/d tricagrelor and 100 mg/d ASA For PCI, prevention and treatment of unstable angina, and AMI. May cause headache, dizziness, bradycardia, bleeding, and dyspnea. Pregnancy category: C ∗ ; PB: 99%: t½: 7 h
Antiplatelet Drugs Dosing & Uses: -- Prasugrel (Effient)
A: PO: Loading dose: 60 mg; maint: 10 mg/d in combination with ASA For PCI, prevention of thrombotic cardiovascular events, and treatment of AMI and unstable angina. May cause headache, dizziness, bleeding, nausea, back pain, and hypercholesterolemia. Pregnancy category: B ∗ ; PB: 98%; t½: 2-15 h
Pradaxa (dabigatran) - What does it do? What do you monitor? What is the antidote? Direct thrombin inhibitor
*NEW COUMADIN* PREVENTS THROMBUS FORMATION Monitor Ecarin Clotting Time (ECT) more accurate marker than PT and PTT -- PT & PTT gives approximation if ECT not available Potential antidote -- Idarucizumab (aDabi-Fab) - Monoclonal antibody --Antibody fragment binds and neutralizes effects of NOACs
Direct Thrombin Inhibitors -- Argatroban (Acova)
- PCI & HIT A: ** IV **: 2 mcg/kg/min infusion; adjust dose to maintain a PTT 1.5-3 times baseline For PCI, HIT, prophylaxis and treatment of DVT and PE; prophylaxis of coronary artery thrombosis. May cause bleeding, hypotension, chest pain, bradycardia, tachycardia, headache, GI distress, back pain, dyspnea, and cardiac arrest. Pregnancy category: B ∗ ; PB: 54%; t½: 39-51 min
Antiplatelet Drugs "Super Aspirin" - Examples
- ReoPro (abciximab), Aggrastat (tirofiban), Integrilin (eptifibatide) *** Used primarily for: --Acute coronary syndromes (unstable angina or non-Q-wave myocardial infarction) --Preventing reocclusion of coronary arteries following percutaneous transluminal coronary angioplasty (PTCA). These drugs are usually given before and after PTCA. Drug of choice for angioplasty is abciximab (ReoPro). --Following IV infusion, the antiplatelet effects lasts for: --- ** Abciximab (ReoPro) ** persist for 24 to 48 hours ---Eptifibatide and tirofiban for 4 hours. All three are administered IV, usually in combination with aspirin and low-dose heparin. Treatment is expensive, costing $1000 or more for a brief course.
Anticoagulants: Warfarin and Heparin Herbal Alert - Herbs that DECREASE EFFECT anticoagulants
-Anise -Alfalfa -Goldenseal -Ginseng -Valerian
Anticoagulants are used prophylactically to prevent
-Clot formation (thrombus) -An embolus (dislodged clot)
Anticoagulants: Warfarin and Heparin Herbal Alert - Herbs that INCREASE bleeding
-Dong quai -Feverfew -Garlic -Ginger -Green tea -Chamomile tea -Ginkgo -Black haw -Bilberry
Warfarin Sodium Coumadin - PO
-Given ORALLY only -Inhibit hepatic synthesis of Vitamin K, thus affecting the clotting factors II, VII, IX, and X -Monitored by prothrombin time (PT) and INR (PT-INR) --PT - NORMAL = 9.5 to 12 SECONDS -Therapeutic range 1- 2.5 times normal --INR - NORMAL IS 1.3 to 2 SEONCDS -Therapeutic range 2.0 - 3.5 -May be started while the patient is still on heparin until PT-INR levels indicate adequate anticoagulation -Full therapeutic effect takes several days -Monitor PT-INR regularly—keep follow-up appointments -Has a long half-life and can accumulate in system leading to bleeding -ANTIDOTE IS VITAMIN K -For acute bleeding = fresh frozen plasma (FFP)
TPA (Ateplase/Activase) NEED TO KNOW
-IV Bolus Dose Or Infusion -High Risk Of Bleeding, Including Cerebral bleeds -Many Contraindications Including Recent History Of Bleeding Reversal Agents: •Aminocaproic acid (Amicar) •Tranexamic Acid (Cyklokapon)
TPA (Ateplase/Activase) WATCH FOR BLEEDING
-Severe, Sudden Onset Headache -Visual Changes -Any Stroke-like Symptoms -Frank Blood In Stool Or Emesis -Frank Blood In Urine -Black, Tarry Stool Indicating Digested Blood -Coffee Ground Emesis Indicating Digested Blood -Oozing From IV Sites -Weakness, Paresthesia Or Paralysis Of Lower Limbs (Indicating Hematoma)
Anticoagulant: Mechanism of Action
-Vary, depending on drug -Work on different points of the clotting cascade -Does not lyse existing clots -Heparin and low-molecular-weight heparins --Turn off coagulation pathway and prevent clot formation -Warfarin --Interferes with synthesis of vitamin K
NOAC Examples:
-Xarelto/Rivaroxaban -Eliquis/Apixaban -Pradaxa/Dabigatran -Savaysa/Arixtra
Hemostasis: Normal Clotting Mechanism
1.Vascular Phase 2.Platelet Phase 3.Coagulation Phase 4.Clot retraction 5.Clot destruction
Heparin-Induced Thrombocytopenia (HIT)
A potentially fatal immune-mediated disorder characterized by reduced platelet counts (thrombocytopenia) These antibodies activate platelets and damage the vascular endothelium, thereby promoting both thrombosis and a rapid loss of circulating platelets. Thrombus formation poses a risk of DVT, PE, cerebral thrombosis, and MI
Antiplatelet Drugs Dosing & Uses: --Dipyridamole (Persantine) - Thromboembolism prophylaxis:
A: PO: 75-100 mg qid in combination with warfarin or 75 mg tid/qid in combination with ASA; max: 400 mg/d; For prevention of thromboembolism associated with prosthetic heart valves. May cause dizziness, headache, GI distress, and chest pain. Pregnancy category: B ∗ PB: 91%-99%; t½: 12 h
Thrombolytic Drugs: Mechanism of Action
Activate the fibrinolytic system to break down the clot in the blood vessel quickly Activate plasminogen convert it to plasmin, which can digest fibrin Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction
Thrombolytics: Side Effects and Adverse Reactions
Allergic reactions can complicate thrombolytic therapy. --Anaphylaxis (vascular collapse) occurs more frequently with STREPTOKINASE than with the other thrombolytics. If administered through an intracoronary catheter after myocardial infarction watch for: --Reperfusion dysrhythmia Hemorrhagic infarction at the myocardial necrotic area can result. *** BLEEDING *** --The major complication of thrombolytic drugs is hemorrhage. Antidote: (plasmiogen inactivators) -- AMINOCAPROIC ACID (Amicar) *** --an antithrombolytic drug is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis.
The patient develops a deep vein thrombosis. The nurse anticipates administration of which medication? A.Intravenous heparin B.Clopidogrel (Plavix) C.Vitamin K D.Protamine sulfate (Protamine)
Answer: A Rationale: Intravenous heparin is indicated for rapid anticoagulant effect when a thrombosis occurs because of a deep vein thrombosis (DVT), pulmonary embolism (PE), or an evolving stroke. The effects of subcutaneous heparin take longer to occur. Clopidogrel (Plavix) is an antiplatelet drug that is mainly for prophylactic use in prevention of myocardial infarction or stroke. Vitamin K is the antidote for warfarin, and protamine is the antidote for heparin.
A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA (Activase). It is most important for the nurse to monitor what? (Select all that apply.) A.Bleeding B.Vital signs C.PT levels D.Allergic reactions E.Electrocardiogram
Answer: A, B, D, E Rationale: The nurse should monitor the patient receiving thrombolytics for adverse effects, such as bleeding, allergic reactions, and cardiac dysrhythmias. An increased heart rate with a decreased BP usually indicates blood loss from bleeding.
A patient is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse anticipates administration of which drug to prevent deep vein thrombosis? A.Dipyridamole (Persantine) B.Low-molecular-weight heparin (Lovenox) C.Abciximab (ReoPro) D.Anagrelide HCl (Agrylin)
Answer: B Rationale: Low-molecular-weight heparins are derivatives of standard heparin and were introduced to prevent venous thromboembolism. The other drugs are platelet inhibitors. Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation.
The patient is being discharged home on warfarin (Coumadin) therapy. Which information will the nurse include when teaching the patient? A.Results of activated partial thromboplastin time (aPTT) will determine if the medication is effective. B.International normalized ratio (INR) results should be between 2 to 3. C.A normal response to warfarin (Coumadin) is for your stools to look tarry. D.Increase the amount of green leafy vegetables in your diet.
Answer: B Rationale: Today, international normalized ratio (INR) is the laboratory test most frequently used to report PT results; a value of 2 to 3 is considered acceptable. Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) are laboratory tests to detect deficiencies of certain clotting factors, and these tests are used to monitor heparin therapy. Tarry stools indicate GI bleeding. Green leafy vegetables contain vitamin K, which is the antidote for warfarin (Coumadin).
A patient is prescribed aspirin, 81 mg, and clopidogrel (Plavix). The nurse identifies the drug classification of clopidogrel as A. anticoagulant. B. thrombotic inhibitor. C. antiplatelet. D. thrombolytic.
Answer: C Rationale: Clopidogrel is an antiplatelet drug.
Warfarin (Coumadin): Side Effects and Adverse Reactions
BLEEDING (hemorrhage) is the major adverse effect of warfarin. Patients should be monitored closely for signs of bleeding •Petechia, ecchymosis, hematemesis Laboratory testing of PT or INR should be scheduled at recommended intervals.
Anticoagulants: Major Adverse Effects
Bleeding/Hemorrhage -Risk increases with increased dosages -May be localized or systemic -10% will hemorrhage
Anticoagulants: Side Effects/Adverse Side effects -Common Side Effects
Bloating and gas Diarrhea Upset stomach or vomiting Feeling less hungry
Antiplatelet Drugs "Super Aspirin"
Blocks the receptor protein (GP IIb/IIa) found on the platelet wall membrane and plays a role in promoting aggregation Prevents binding of fibrinogen on platelets They are called platelet glycoprotein (GP) IIb/IIIa receptor antagonists.
Coumadin Vs. Heparin
COUMADIN -PO Medication -Requires Frequent Lab Draws -Dietary Intake Of Leafy Greens (Vit K) Must Be Consistent -Dose Is Adjusted Based On INR (Goal 2.0 - 3.0) ** -Reversal Is Vit K And FFP/Clotting Factors HEPRAIN -SQ Dose Is Typically Standard (5,000 Units Is Common) -Infusion Dose Is Adjusted -Based On PTT And Goals Of Therapy ** -No Spinal Punctures Or Epidurals -Reversal Is Protamine Sulfate
Drug: Heparin
Commonly prescribed to prevent pulmonary embolism from: -DVT -After orthopedic or abdominal surgery MONITORED BY: -aPTT - Activated partial thromboplastin time and -PTT - partial thromboplastin time (PTT) - ** PTT: NORMAL 60-70 SECONDS **: - THERAPEUTIC RANGE 1.5 to 2.5 TIMES BASELINE VALUES (USUALLY MAINTAIN AROUND 90 SECONDS PTT less than 50 sec increase dose PTT over 100 sec decrease dose *** Parenteral (SC or IV) Short half-life (1 to 2 hours) Action: Inactivates THROMBIN in coagulation cascade Reversal agent - * PROTAMINE SULFATE * Obtained from sheep, cows, and pigs Natural substance produced in the liver
Novel Oral Anticoagulants (NOACs) Direct Xa Inhibitor "XABAN"
Compared to warfarin, the NOACs have significant advantages: --Reduced monitoring, fixed dosing, faster onset and offset, and fewer drug interactions. The novelty and unfamiliarity of these agents can possibly lead to dangerous drug interactions being overlooked and subsequent patient harm. Adverse effects HEMORRHAGING **
Anticoagulants: Side Effects/Adverse Side effects - Less Common Side Effects
Coughing up or throwing up blood Dark stools A skin rash, hives, or itching Sore throat Hair loss Bruising more often Back pain Fever, chills, or weakness Yellowing of the skin or eyes (jaundice)
Direct Xa Inhibitors "XABAN" Novel Oral Anticoagulants (NOACs) -- Apixaban (Eliquis)
DVT, PE: A: * PO *: 10 mg bid for 7 d then 5 mg bid for 6 months; max: 10 mg/d To prevent and treat DVT and PE and for prevention of stroke and atrial fibrillation. May cause bleeding, hematoma, and anemia. Pregnancy category: B ∗ ; PB: 87%; t½: 12 h
Heparin: Nursing Implications
DOSE - DOUBLE CHECKED W/ ANOTHER NURSE Ensure that SC doses are given SC, not IM SC doses should be given in areas of deep subcutaneous fat, and sites rotated -Standard SC dose - 5,000 units Do not give SC doses within 2 inches of: Umbilicus, abdominal incisions, or open wounds, scars, drainage tubes, stomas DO NOT ASPIRATE SC injections or MASSAGE injection site --May cause hematoma formation Laboratory values are done daily to monitor coagulation effects (aPTT or PTT) PROTAMINE SULFATE can be given as an antidote in case of excessive anticoagulation Watch for Bleeding: --Epistaxis, hematuria, petechial, purpura, stool for occult blood, vital signs for internal bleeding No spinal punctures or epidurals
Direct Thrombin Inhibitors -- Desirudin (Ieprivask)
DVT A: * SUBCUT *: 15 mg q12h for 9-12 d, give first dose 5-15 min before surgery For DVT prophylaxis. May cause bleeding, hematoma, injection site reaction, and anemia. Pregnancy category: C ∗ ; PB: UK; t½: 2-3 h
Direct Xa Inhibitors "XABAN" Novel Oral Anticoagulants (NOACs) -- Fondaparinux (Arixtra)
DVT, PE: *SUBCUT *: 2.5-10 mg/d for 5-9 d For prophylaxis and treatment of DVT and PE. May cause bleeding, anemia, and insomnia. Pregnancy category: B ∗ ; PB: 94%; t½: 18 h
Direct Xa Inhibitors "XABAN" Novel Oral Anticoagulants (NOACs) -- Edoxaban (Savaysa)
DVT, PE: A: *PO *: 30-60 mg/d after 5-10 d of initial therapy with parenteral anticoagulant; max: 60 mg/d For treatment of DVT, PE, and nonvalvular atrial fibrillation and stroke prophylaxis. May cause bleeding, elevated hepatic enzymes, and anemia. Pregnancy category: C ∗ ; PB: 55%; t½: 10-14 h
Thrombolytic therapy - 'Clot Busters" --
Fibrinolytics DISSOLVE (CLOT) THROMBI IN THE CORONARY ARTERIES AND RESTORES MYOCARDIAL BLOOD FLOW -- Promotes conversion of plasminogen to plasmin Alteplase (Activase), tPa (tissue plasminogen activator) - ** STROKES ** Reteplase (Retavase), r-PA - IV or intracoronary - * MI ** Tenecteplase (TNKase) IV push Streptokinase (Streptase) Urokinase (Abbokinase) --Most effective when given within * 6 HOURS * of coronary event "Door to needle time" --Watch for bleeding and monitor clotting studies --WATCH FOR INTERNAL BLEEDING --Hgb and Hct --Test stools, urine and emesis for occult blood
Thrombolytic Drugs: Nursing Implications
Follow strict manufacturer's guidelines for preparation and administration Monitor: -- IV sites for bleeding, redness, pain --Monitor for bleeding from gums, mucous membranes, nose, injection sites Observe for signs of internal bleeding --decreased BP --restlessness --increased pulse
enoxaparin (Lovenox)
Given by SQ injection Dose is adjusted for renal impairment Do not eject air bubble No spinal punctures or epidurals Reversal is PROTAMINE SULFATE
Anticoagulants: Side Effects/Adverse Side effects Rare Side Effects
Headache Dizziness Shortness of breath Mouth sores or bleeding gums Purple coloring to your fingers or toes
What are Anticoagulant Drugs?
Inhibit the action or formation of clotting factors PREVENT CLOT FORMATION DOES NOT DISSOLVE A CLOT
Antiplatelet Drugs Dosing & Uses: -- Cilostazol (Pletal)
Intermittent claudication and PVD A: PO: 50-100 mg bid; max: 200 mg/d For intermittent claudication and PVD. Smoking may decrease serum levels. May cause headache, diarrhea, GI distress, nasopharyngitis, dizziness, infection, palpitations, and peripheral edema. Pregnancy category: C ∗ PB: 95%-98%, t½: 11-13 h
Low-Molecular-Weight Heparins (LMWH)
Lovenox, Fragmin and Innohep "PARIN" Action: -Inactivates factor Xa and thrombin in coagulation cascade Examples: Øenoxaparin (Lovenox), dalteparin (Fragmin) & tinzaparin (Innohep) More predictable anticoagulant response ---Usually does not affect PT & PTT Does not require frequent laboratory monitoring Given subcutaneously Antidote: --PROTAMINE SULFATE can be given as an antidote in case of excessive anticoagulation Contraindications --For patients with strokes, peptic ulcers, and blood anomalies. --Should not be given to patients having eye, brain, or spinal surgery.
what are thrombolytic drugs
Lyse (break down) existing clots "Clot busting drugs" DISSOLVES CLOTS
Thrombolytics: Indications
Myocardial infarction --Thrombus, or blood clot, disintegrates when a thrombolytic drug is administered within 4 hours. Thrombolic stroke --ØThrombolytic drug should be administered within 3-4 hours. Pulmonary embolism DVT Noncoronary arterial occlusion from an acute thromboembolism
NOAC Need To Know
NEW GENERATION ANTICOAGULANTS -PO Medication -No Regular Monitoring Or Need For Frequent Lab Visits -No Need To Limit Vit K Intake -No Spinal Punctures Or Epidurals -Teach Pt To Monitor For Signs Of Bleeding -There Is No Antidote -Antidote for Pradaxa - Idarucizumab (aDabi-Fab)- Monoclonal antibody
Novel Oral Anticoagulants (NOACs) Direct Xa Inhibitor "XABAN" -- Examples of Drugs:
NOACs: Xarelto (rivaroxaban) Eliquis (apixaban) Savaysa (Edoxaban) MOA: Inhibits thrombin from converting fibrinogen to fibrin
Anticoagulant Examples:
No direct effect on a blood clot that is already formed -Prevents further clotting Heparin (unfractionated) - SC & IV -Low-molecular-weight heparin - SC enoxaparin (Lovenox) dalteparin (Fragmin) -Warfarin (Coumadin, Jantoven) - Oral -Selective factor Xa inhibitors - Novel oral anticoagulants Pradaxa (diabigatran) PO Xarelto (rivaroxaban) PO Eliquis (apixaban) PO
Thromboembolism
Occlusion of an artery or vein caused by a thrombus or embolus results in: -ISCHEMIA (deficient blood flow) that leads to -NECROSIS (death) of the tissue distal to the obstructed area. It takes approximately 1 to 2 weeks for the blood clot to disintegrate by natural fibrinolytic mechanisms. If a new thrombus or embolus can be dissolved more quickly •Tissue necrosis is minimized •Blood flow to the area is reestablished faster. This is the basis for thrombolytic therapy
Direct Thrombin Inhibitors -- Bivalirudin (Angiomax)
PCI (Percutaneous Coronary Intervention) A: ** IV bolus **: 0.75 mg/kg; then IV infusion of 1.75 mg/kg/h during and within 4 h post-procedure; max: 1.75 mg/kg/h infusion For thrombosis prophylaxis in PCI, unstable angina, and HIT. May cause bleeding, headache, hypotension, GI distress, insomnia, anxiety, back and pelvic pain, and bradycardia. Pregnancy category: B ∗ ; PB: 0%; t½: 25 min
Antiplatelet Drugs Dosing & Uses: -- Clopidogrel (Plavix)
PO To prevent thrombosis associated with unstable angina, AMI, stroke, TIA Mode of Action: Inhibits platelet aggregation and prevents ADP from binding with the ADP platelet receptor
What are the antiplatelet drugs?
PREVENT PLATELETS FROM AGGREGATING TO FORM CLOTS Most effective in preventing arterial thrombosis
Anticoagulants: Indications
Prevent clot formation or prevent further clotting -Myocardial infarction -Unstable angina -Atrial fibrillation -Indwelling devices, such as mechanical heart valves -Major orthopedic surgery -Deep vein thrombosis (DVT) -Pulmonary embolism (PE)
Antiplatelet Drugs:
Prevent platelet adhesion (aggregation) Aspirin •ACETYLSALICYLIC ACID •Long-term, low-dose therapy •Inhibits cyclooxygenase --An enzyme needed by platelets to synthesize thromboxane A2 (TxA2) Dipyridamole •PERSANTINE Thienopyridines - Adenosin diphosphate (ADP) inhibitors •PLAVIX (clopidogrel) ** •TICLIDE (ticlopidine) ** •EFFIENT (prasugrel) **
Thrombolytic Drugs: Nursing Implications -- Monitor for Adverse Effects
Signs of excessive bleeding •Bleeding of gums while brushing teeth, unexplained nosebleeds, heavier menstrual bleeding, bloody or tarry stools, bloody urine or sputum, abdominal pain, vomiting blood Adverse effects •Increased BP, headache, hematoma formation, hemorrhage, shortness of breath, chills, fever
Direct Thrombin Inhibitors -- Dabigatran (Pradaxa)
Stroke & AFIB - New Coumadin A: * PO *: 150 mg bid; max: 300 mg/d For prevention of stroke and for prophylaxis and treatment of atrial fibrillation, DVT, and PE. May cause bleeding and GI distress. Pregnancy category: C ∗ ; PB: 35%; t½: 12-17 h
Direct Xa Inhibitors "XABAN"Novel Oral Anticoagulants (NOACs) -- Rivaroxaban (Xarelto)
Stroke prophylaxis: A: * PO *: 20 mg/d with evening meal; max: 30 mg/d, DVT and PE prophylaxis: A: PO: 15 mg bid for 21 d, then 20 mg/d for 6 months For prophylaxis of DVT, PE, and stroke and for atrial fibrillation. May cause bleeding and back pain. Pregnancy category: C ∗ ; PB: 92%-95%; t½: 5-9 h
Anticoagulants - Contraindications
Stroke, peptic ulcer, blood anomalies Patients having eye, brain, or spinal surgery
ANTIPLATELETS ARE USED TO
Used to PREVENT THROMBOSIS IN THE ARTERIES by suppressing platelet aggregation Heparin and warfarin PREVENT THROMBOSIS IN THE VEINS Prophylactic use to prevent: -Myocardial infarction -Stroke for patients with familial history -A repeat myocardial infarction or stroke -Stroke for patients having transient ischemic attacks
Warfarin (Coumadin): Antidote
Vitamin K1 (Mephyton, AquaMephyton) Antidote for warfarin overdose (Antagonist of warfarin) Used for warfarin overdose or uncontrollable bleeding --24 to 48 hours to be effective --Usually 1 to 10 mg of vitamin K is given at once Failure to control bleeding: •Fresh whole blood •Fresh-frozen plasma (FFP) •Platelets
Warfarin: Drug Interactions
Warfarin is highly protein-bound Affected by drug interactions with: -Antiinflammatory Drugs •Aspirin •Nonsteroidal antiinflammatory drugs (NSAIDs) -Sulfonamides -phenytoin (Dilantin) -cimetidine (Tagamet) -allopurinol (Zyloprim) -Oral hypoglycemic drugs for diabetes Acetaminophen (Tylenol) should be used instead of aspirin by patients taking warfarin.
Although anticoagulants are called blood thinners, these medications...
do not really thin your blood. They decrease the blood's ability to clot. Decreased clotting keeps fewer harmful blood clots from forming and from blocking blood vessels
Anticoagulants reduce the risk for what?
heart attack, stroke, and blockages in the arteries and veins by preventing clumps of blood (blood clots) from forming or growing. Anticoagulants CANNOT BREAK UP BLOOD CLOTS THAT HAVE ALREADY FORMED
