Coagulation Modifier Agents
Lilley Pharmacology Text: Chapter 26
Original Text modified by:
Anita A. Kovalsky, R.N., M.N.Ed.
Professor of Nursing
Original PPT by:
Professor Pat Woodbery, ARNP
Professor of Nursing
What is Hemostasis?????
In other words……..
What Upsets the Balance
between Thrombogenesis and Thrombolysis???
Atherosclerosis
Immobility (particularly after surgery)
Dysrhythmias (Atrial Fibrillation)
Artificial Heart Valves
These clients require prophylactic anticoagulation or……
A Thromboembolic Event May Occur…
Thrombophlebitis
Deep vein thrombosis (DVT)
Myocardial Infarction (MI)
Pulmonary Embolus (PE)
Cerebrovascular Accident (CVA)
Coagulation Modifiers: Categories
and Agents
(Lilley pg. 410 Table 26-1)
Prototype Anticoagulants
(Trade name in parentheses)
(Lilley pg. 415; Syllabus pg.41)
Heparin
(SQ or IV)
Half-life 1-2 hrs
Enoxaparin (Lovenox)
(SQ)
Half-life 4.5 hrs
Warfarin (Coumadin)
(PO)
Half-life 0.5-3 days
HEPARIN
Turns off 3 main activating factors:
II (thrombin)
IX
X
And to a lesser extent XI & XII
ENOXAPRIN (LOVENOX)
A low molecular weight heparin
(LMWH) which is more predictable
More specific for turning off activating factors:
X
And to a lesser extent II (thrombin)
WARFARIN (COUMADIN)
More specific for turning off activating factors:
II
VII
IX
X
These factors rely heavily on Vitamin K for synthesis, so Warfarin works by interfering with proper production of Vitamin K
Lab Work for Therapeutic Regulation of Anticoagulant Medications (Cavenaugh pp. 49-52)
aPTT (1.5 –2.0 x control) = Heparin
(Activated Partial Thromboplastin Time)
INR (2.0-3.0 seconds for oral anticoagulation = Warfarin
(International Normalized Ratio)
PT (1.5-2.5 x control) = Warfarin
(Prothrombin Time)
Systemic Hemostatic Agents
(Lilley pg. 413; Syllabus pg.41)
NURSING ACTIONS FOR HEPARIN AND ORAL
ANTICOAGULANTS
(Lilley pp. 426-427)
Rationale for drug
Correct dose
Site assessment
Check labs for therapeutic effects
Monitor for adverse effects
ANTICOAGULANT
PATIENT TEACHING
(Lilley pp. 414 & 430)
Increase risk of BLEEDING: avoid trauma
Periodic blood tests for Coumadin Therapy
Note OTC medications
Note diet
Prototype
Antiplatelet Agents
(Trade name in parentheses)
(Lilley pg. 419; Syllabus pg.41)
Acetylsalicylic Acid (Aspirin)
Clopidogrel (Plavix)
ANTIPLATELET
PATIENT TEACHING
(Lilley pg. 430)
Increase risk of BLEEDING: avoid trauma
ASA precautions
No ETOH or cigarette smoking
Note timing of antacids
Note diet
THE END