Final: Anticoagulants

Question 1

Aspirin

Answer 1

Primary and secondary prevention of MI, prevention of stroke (pt hx of TIAs)

Adverse effects: GI upset and bleeding (take with food, enteric coated), hemorrhagic stroke, salicylate toxicity (ringing in ears), Reye’s with children

Contraindications: Peptic ulcer disease, thrombocytopenia

Monitoring: bleeding, GI upset, avoid overuse

Question 2

Clopidogrel

Answer 2

Antiplatelet

Adverse effects: Bleeding, TTP (rare purple rash, check CBC for low platelets, usually occurs in first 2 weeks)

Teaching: Monitor for GI side effects, bleeding, bruising. Take with or without food but NOT with proton pump inhibitors. Stop 1 week before surgery

Question 3

Heparin

Answer 3

Inhibits fibrin formation

Treats PE, DVT, stroke when prompt anticoagulant activity is needed, low dose for prophylaxis for surgery, disseminated intravascular coagulation

Contraindications: Thrombocytopenia, high risk of bleeding (peptic ulcer, severe HTN), post op surgeries to brain, eye, spinal cord, lumbar puncture

Adverse effects: Hemorrhage, thrombocytopenia, hypersensitivity

Antidote: Promatine sulfate (1mg/100u heparin)

Monitor: Frequent monitoring and titration of drip rate based upon aPTT time (therapeutic: 1.5-2x control, want the level to be high on heparin), avoid aspirin, report bleeding/bruising/dark tarry stools

Question 4

Enoxaparin (Lovenox)

Answer 4

Prevents DVT post-op, treats DVT and PE, prevent complications in MI

Contraindications: Thrombocytopenia, high risk of bleeding (peptic ulcer, severe HTN), post op surgeries to brain, eye, spinal cord, lumbar puncture

Monitoring: Does not require PTT monitoring, monitor platelets, consistent intake of high vitamin K foods

Adverse effects: Bleeding

Antidote: Protamine sulfate

Question 5

Warfarin

Answer 5

Antidote: Vitamin K

Contraindications: High risk of bleeding, post op brain/eye/spinal cord, liver disorders, alcohol use disorder

Monitor: Bleeding, PT time (1.5-2x base level), INR (1.1 or lower is normal, desired therapeutic range 2-3), consistent intake of high vitamin K foods

Question 6

Management of bleeding with thrombolytics

Answer 6

Use whole blood, FFP if bleeding is excessive

Use amniocoproic acid if blood products are ineffective

Question 7

Management of bleeding

Answer 7

Minimize physical manipulations of PT
Avoid sub-q or IM injections
Minimize invasive procedures (no foley)
Manual BP
Minimize concurrent use of anticoagulants and antiplatelet drugs
Monitor aPTT, PT, INR
Monitor CBC (hemoglobin, hematocrit)

Question 8

Complementary therapies that suppress platelet aggregation

Answer 8

Feverfew
Ginger root
Glucosamine
Garlic
Ginko Biloba