·
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.
