Anti-coagulation Flashcards
Warfarin
what pt do we not want to give warfarin to?
purple toe syndrome (rare) within first days of starting: skin necrosis
normal 1
heart valves 2-3
Surgery: stop 5 days in advance, do not give if had surgery or bleeding
*interacts with aspirin, Tylenol, anti-fungal, anti-acids, anti-depressants, and antibiotics.
-Asians require low dose
-reversal: vit K (phytonadione)
Plavix- clopidogrel
takes 10 days for platelets to return to function
Reversal agents
vit K- coumadin
desirudin, bivalirudin (direct thrombo inhibitors–> Praxbind
Xarelto/ Eliqus–> Andexxa
Heparin–> protamine sulfate
Plavix–> fresh frozen plasma or cryoprecipite
salicylate–> takes 4 days for PTL function to come back
The antidote for warfarin is?
vit K PO or IV
Patients INR 5-10 what do we do?
INR more
no bleeding do nothing
INR greater 10
PO vit K unless pt is bleeding than they need IV vit K, hold warfarin (admitted for monitoring)
What is the black box for lovenox?
Lovenox “low molecular wt option no IRN screening
Black box: do not give for spinal anesthesia pts b/c risk of a hematoma on the spine and can lead to paralysis.
What if pt is pregnant and need anti-coagulation?
Warfarin or lovenox?
Lovenox does not cross placenta
warfain is not used
anti-platelets work by?
how long do you stop aspirin prior to surgery?
aspirin works to prevent platelets from clumping together.
- used in the prevention and treatment in CAD, stroke, RA, MI,
-s/s of bleeding education like GI bleeds
7-10 days (prior to surgery)
Plavix when do you prescribe it.
prescribed if you have an allergy to asprin
and also used after a stent.
The nurse practitioner is aware that when a patient is prescribed enoxaparin (Lovenox) long-term, levels of this drug can be monitored with which of the following labs?
anti-Xa. The gold standard for determining the concentration of enoxaparin (Lovenox) in the blood is an anti-Xa assay.
