Anticoagulants Heparin Warfarin Low-molecular-weight Inhibit action or formation of clotting factors. Prevent clot formation. prolong bld time.

Monitored by activated Monitored by prothrombin Longer duration of action partial thromboplastin time (PT) and INR (PT-INR) than that of heparin. More times (aPTTs). stable response. Pt can give own injections at home. Drug of choice preventing DVT following surgery. Antagonist: Protamine Antagonist: Vitamin K More predictable response sulfate Doesnt require frequent lab monitoring because Parenteral or subcu (never Given orally only they are dose related to IM). Short half-life (1 to 2 May be started while the the pts weight. Given SC hrs) patient is still on heparin Comes in a pre-filled SC doses should be given in until PT-INR levels indicate syringe. Pt may go home areas of deep subcu fat adequate anticoagulation on injections such as the abdomen Full therapeutic effect Ensure that SC doses are unless ordered otherwise, takes several days & sites rotated. Dont give Monitor Prothrombin time given SC, not IM (SC action takes up to 1 hour) SC doses /in 2 of: PT -normal range is 11 to SC doses should be given in umbilicus, incisions, open 13 seconds, therapeutic wounds, scars, drainage should be one to two times areas of deep subcutaneous fat such as tubes, or stomas. the patients normal value the abdomen unless Do not aspirate or massage International normalized ordered otherwise, and & injection site (May cause ratio (INR) - 2.0 to 3.5 are sites rotated hematoma formation). therapeutic. IV dose- bolus or infusions Teach: balance of vitamin K Do not give SC doses within 2 inches of: (onset of act immediate) foods, keep lab appts. The umbilicus, abdominal Lab values are done daily incisions, or open wounds, to monitor coag effects scars, drainage tubes, (aPTT), (normal values ranging from 25 to 40 seconds). stomas Therapeutic Do not aspirate SC anticoagulation the aPTT injections or massage should be one to two times injection site the pts baseline. AE: blding (risk ^ w/ ^ dosages) may be localized or systemic, N/V, abdominal cramps, thrombocytopenia. N con: Assess-VS, lab values, existence of underlying renal or hepatic disorders. Teach: Report burning, stinging, warmth, excessive bruising, pain or swelling at IV site. Take warfarin same time each day, avoid hazardous activities. Report: nosebleeds, excessive menstrual flow, bleeding gums, or bruising, limit garlic intake, use soft bristle tooth brush & electric razor, hold pressure on cuts 20 minutes. 2RN check.

Antiplatelet Inhibit platelet aggregation Prevent platelet plugs. interfering with the various aspects of platelet function (platelet aggregation)

Aspirin (OTC) Potent medication Effect of single dose may persist for as long as a week. Do not use with other anticoagulants unless prescribed by MD. Used to prevent stroke (CVA) & MI. Can be given concurrently with anticoagulants (what for ^ risk of bleeding) Puncture IV sites or cuts may require increased pressure applied to stop the bleeding Monitor for ecchymoses

Thrombolytic Lyse, or breakdown, existing clots. Dissolve. Goal to restore bld flow o tissue served by blocked vessel. Used in: Acute MI Pulmonary embolism Acute ischemic stroke (CVA), o rDVT Best to be administered within 4 hrs. Can cause severe bleeding (stop transfusion if occurs) Monitor VS continuously. Administered in the critical care area or ER. Conditions that exclude pt from receiving thrombolytics: Recent trauma, sx or biopsies, arterial emboli, cerebral embolism, hemorrhage, thrombocytopenia. septic thrombophlebitis. & child birth within 10 days. Obtain baseline coagulation tests (aPTT, bleeding time, PT, and/or INR); hematocrit, hemoglobin and platelet count.

Antifibrinolytic Promote blood coagulation. Action opposite to anticoagulant, shorten bleeding time

Indications Prevention & tx of excessive bleeding (Hyperfibrinolysis, surgical complications, excessive oozing from surgical sites such as chest tubes, reducing total blood loss and duration of bleeding in the postoperative period)

N.C: mon for blding with trauma or surgery. Aspirin can cause gastritis or GI bleeding, may cause nausea or GI upset (administer with food)

Monitor LOC, check neurological status Observe for dysrhythmias Only given IV.never IM

NC: Monitor peripheral pulses. Monitor for paresthesias, Chest pain or SOB. Monitor for pulmonary thrombus or embolus