Monday, April 2, 2012

ANTICOAGULANTS, ANTIPLATELETS, AND THROMBOLYTICS


  
·         Inhibits clotting factors and decreases blood coagulability to prevent formation of clots (anticoagulants), activates plasminogen which generates plasmin to dissolve clots (thrombolytics), inhibits platelet aggregation (antiplatelet)
·         Indication:
o    Thrombosis, pulmonary embolism, MI, valve replacement
·         Contraindication:
o    Anticoagulant: active bleeding, blood dyscrasias, ulcers, liver and kidney disease, spinal cord or brain injuries
o    Thrombolytics: active internal bleeding, history of CVA, recent surgery or trauma, hepatic or renal disease, uncontrolled hypertension, recent cardiopulmonary resuscitation
o    Antiplatelets: bleeding disorders

Example:
Anticoagulants:
o    anisindione (Miradon®)
o    warfarin sodium (Coumadin®)
o    heparin sodium (Liquaemin®)
o    enoxaparin (Lovenox®)
Thrombolytics:
o    t-PA: alteplase (Activase®)
o    streptokinase (Streptase®, Kabikinase®)
o    urokinase (Abbokinase®)
Antiplatelets:
o    acetylsalicylic acid (Aspirin®)
o    ticlopidine (Ticlid®)

Side Effects:

·         Hemorrhage
·         Unusual bruising or bleeding
·         Epistaxis
·         Hematuria
·         Occult blood in the stool
·         Thrombocytopenia
·         Hypotension

Nursing Considerations:

ü  Monitor the following:
o    Heparin sodium- clotting time and aPTT; maintain clotting time at 15 to 20 minutes and  aPTT at 1.5 to 2.5 times normal
o    Warfarin sodium- PT and INR; target INR maybe 2 to 3 or 3 to 4.5 for some patients
o    Alteplase, streptokinase- aPTT, PT, fibrinogen level, hematocrit, platelet count
o    ASA, Ticlopidine- bleeding time
ü  Observe for signs of bleeding.
ü  Antidote:
o    Heparin- protamine sulfate
o    Warfarin- vitamin K (Phytonadione, AquaMephyton)
ü  Provide patient teaching regarding the use of the medication and measures to prevent bleeding. 




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