Anticoagulants, Antiplatelets & Thrombolytics Flashcards
Heparin
- Anticoagulant
- IV & SubQ
- Measured in units
MOA:
- Inhibits activation of Vitamin K
Indication:
- Prophylactic: pts at high risk for thromboembolism
- Therapeutic: prevents clot enlargement
- While waiting for the onset of Warfarin (3-5 days)
Adverse Effects:
- Heparin-induced thrombocytopenia
- Bleeding with OD
Nursing:
- Onset of action: 20 min
- Duration lasts 8 hours
- Labs to monitor: aPTT, platelet count for thrombocytopenia (HIT)
- Antidote: FFP, protamine sulfate IV, or wait 6-8 hours
Enoxparin
- Anticoagulant
- SubQ only
- Measured in mg
MOA:
- Inhibits activation of Vitamin K
Side Effects:
- Stinging for a few minutes after injection
Nursing:
- Do not massage the area of injection
- Prefilled syringes
- Duration of action: 12 hours
- No labs to monitor
- Antidote: FFP, protamine sulfate IV, or wait 12-24 hours
Warfarin
- Anticoagulant
- PO
MOA:
- Inhibits activation of Vitamin K
Side Effects:
- bleeding
Contraindication:
- pregnancy (switch to heparin)
- thrombocytopenia
- chronic liver disease
- ETOH abuse
Nursing:
- Requires frequent monitoring –> PT (18-24 sec), INR (2-3)
- Takes 3-5 days for INR to reach therapeutic level
- Long 1/2 life –> takes 5 days for INR to be normal after discontinuing the drug
Patient Education:
- Eat green leafy vegetables
- Frequent PT/INR monitoring; keep a diet/dose log
- Avoid ETOH
- Antidote: phytonadione (PO, SubQ, IM, IV), FFP transfusion
Aspirin & Clopidogrel
- Antiplatelet
- PO
MOA:
- Prevents platelet aggregation
Indication:
- Prophylactic for pts at risk for thromboembolism
Adverse reactions:
- Hemorrhage: particularly GI bleed
Contraindications:
- Pregnancy
- Hx of bleeding disorders
- Retinal/cerebral hemorrhage
- Thrombocytopenia
- PUD
- Aneurysm
- Uncontrolled HTN
- NEVER to kids under <19 years old (risk of Reye’s syndrome)
- NEVER while breastfeeding
- Takes 7 days to clear
Nursing Interventions (monitoring):
- Take with food to minimize GI upset/ GIB
for Hx. of GIB, PUD:
- Enteric-coated aspirin, don’t crush
- Buffered aspirin (mixed with calcium carbonate)
- Reversal agent: platelet transfusion
Interactions (with drugs/food/UV light):
- Avoid NSAIDs (increased risk of GI bleed)
- Avoid alcohol (increased risk of GI bleed)
Eptifibatide
- Antiplatelet
- IV
MOA:
- Prevents platelet aggregation
Indication:
- Prophylactic for pts at risk for thromboembolism
Adverse reactions:
- Hemorrhage: particularly GI bleed
Contraindications:
- Pregnancy
- Hx of bleeding disorder
- Retinal/cerebral hemorrhage
- Thrombocytopenia
- PUD
- Aneurysm
- Uncontrolled HTN
- Duration of action: anti platelet effect lasts 4 hours
Nursing Interventions (monitoring):
- Take with food to minimize GI upset/ GIB
for Hx. of GIB, PUD:
- Enteric-coated aspirin, don’t crush
- Buffered aspirin (mixed with calcium carbonate)
- Reversal agent: platelet transfusion
Interactions (with drugs/food/UV light):
- Avoid NSAIDs (increased risk of GI bleed)
- Avoid alcohol (increased risk of GI bleed)
Alteplase (tPA)
- Thrombolytic
Mechanism of Action:
- Dissolve the clots by fibrinolysis (naturally it takes 1-2 weeks)
Indication:
- Within 4hrs of the onset of MI or ischemic CVA symptoms
- PE, DVT, restore patency of IV catheters
Contraindication:
- BP > 180/110
- hemorrhagic diseases (PUD), neoplasm, recent CNS trauma, aneurism
- recent CVA, AC use, thrombocytopenia, ASA, NSAIDs, pregnancy
Adverse reactions:
- bleeding
- hemorrhagic CVA
- spinal cord infarction
- N/V, fever & angioedema
- anaphylactic shock
- rhabdomyolysis
- dysrhythmias
- pulmonary edema
Medication Administration:
- IV bolus followed by drip for 60 min, tapering dose
- Goal: resolution of symptoms (t1/2 :35 min), given in ICU, ED
- Avoid all AC & antiplatelet until thrombolytic effect is cleared (3hrs)
Nursing Interventions (monitoring):
- Antidote: aminocaproic acid PO/IV, FFP, PRBC
- Monitor trend of VS and assessment (q 15 min)
- Monitoring for: resolution of symptoms (CP, neurological deficit), active bleeding, allergic reaction (hives, angioedema, & dyspnea, anaphylaxis)
- Cardiac monitoring (risk of reperfusion dysrhythmia treated with beta-blockers)
- Avoid venipuncture/arterial sticks, injections (SubQ/IM) as possible
- Hold pressure for 30 min
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