Drugs that Affect the Blood

Coagulation
Hematologic Agents
 Anticoagulants
“prevent thrombus (blood clot)
formation”
• Effective in preventing venous thrombosis
• Prevent clot formation/extension
• Do not dissolve clots
• Increase blood flow to prevent necrosis;
interfere with clotting process
• Most common: Heparin & Coumadin
 Heparin sodium
• MOA: inhibits conversion of fibrinogen to fibrin by
activating antithrombin II = prevents a stable fibrin clot
• Indications:
• Prophylaxis / Tx of thromboembolic disorders
– Deep Vein Thrombosis (DVT)
– Pulmonary emboli (PE)
• Maintain IV patency (IV flush)
• Drug of choice for orthopedic surgeries
• Post-op prolonged bed rest (>5days)
• Prevents clots r/t artificial heart valves
• Treats Disseminated Intravascular Coagulation (DIC)
widespread clotting depletes coagulation factors; Heparin
slows the process to rebuild factors
 Adverse effects
• Hemorrhage
• Thrombocytopenia
• Pain at injection site

Drug Interactions
• Increased risk of bleeding
– ASA “antiplatelets”
– Thrombolytic agents
• Increased anticoagulant effect
– Digitalis
• Long-term use
– Alopecia
– Osteoporosis
 Precautions
•Contraindications:
»Active hemorrhage
»GI ulcers
»Liver or kidney disease
»Recent eye surgery
Low Molecular Weight Heparins
(LMWHs)
•enoxaparin (Lovenox)
•dalteparin (Fragmin)
•No daily monitoring of labs
•Uses:
– Outpatient therapy
– Treats DVT
– Ml w/ASA promote cardiac circulation
– Complications r/t unstable angina
 Nursing Interventions
• Health Hx (bleeding disorders or potential risks)
• Monitor labs
• partial thromboplastin (PTT) PTT is 1.5 - 2.5 times the
“normal” value (daily when continuous IV infusion)
• Platelet counts
• Assess for bleeding - gums, GI bleed (guaiac +
stools)
• Admin SC lower abdomen; “No” IM injections
• Antidote is Protamine Sulfate for heparin
overdose
• Nomogram (sliding scale for heparin infusion
based on lab studies)
 Patient Education
• Wear Medic Alert
• Follow-up appts; labs
• Notify providers of bleeding
• Avoid razors
• Avoid ASA or other antiplatelets
• Dietary: vitamin K alters effectiveness
 warfarin sodium (Coumadin)
• MOA: alters the liver’s ability to synthesize
Vitamin K dependent clotting factors; no effect on
circulating clotting factors or platelet function
• Admin orally; effects after 3-5 days
• Indications:
• Long term prevention of thromboembolic
disorders
– Deep Vein Thrombosis (DVT)
– Pulmonary emboli (PE)
• Manage MI to reduce risk of death, recurrent MI
• Contraindications:
• Gastric ulcers
• Recent eye or spinal cord surgery
 Coumadin con’t
• Cramps / nausea with initial dose
• Begin admin while heparin is being admin IV
• Antidote is Vitamin K IM for overdose
• Monitor prothrombin time (PT) 1-1.5 times the
normal
• Monitor International Normalized Ratio (INR)
• Monitor for bleeding
• Dietary teaching avoid foods high in vitamin K
– leafy green vegetables (spinach, mustard
greens etc…)
 Antiplatelets
prevent arterial thromboembolism

• MOA: interfere with initial phase of blood

coagulation; inhibits platelet aggregation
• Uses:
• Prevent MI
• Stroke in clients w/ TIA (transient ischemic attacks)
• Thromboemboli in pts w/ artificial heart valves
• Adverse effects:
• Increased bleeding
• GI bleeding, dyspepsia
 Important Drugs
• ASA
• Analgesic/antipyretic
• Inhibit prostaglandins
• Reduces TIA
• Small doses
• dipyridamole (Persantine)
• Recommended for use after cardiac valve
replacement admin with Coumadin; dilates coronary
arteries
• ticlopidine (Ticlid)
• Prevents strokes in person w/ a history of stroke
(CVA) who are unable to tolerate ASA
• abciximab (ReoPro)
• Admin with percutaneous transluminal coronary
(PCTA)
angioplasty to prevent rethrombosis; given w/ASA &
Nursing Interventions & Pt. Education
• Monitor VS routinely
• EKG
• Assess for symptoms of stroke
• Monitor labs bleeding times, CBC q2weeks
for 3 months
• Admin after meals w/full glass of water;
antacid to decrease gastric irritation
• Report tinnitus, unusual bleeding
• Avoid ETOH use
• Follow up visits especially during the first 3
months
 Thrombolytic agents
• altepase (Activase)
• streptokinase (Streptase)
• Meds used to dissolve a preexisting clot
• Used in acute and emergency
situations
• Tx MI to re-perfuse myocardium
• Reestablish blood flow in arteriovenous
cannulas (dialysis)
• central venous catheters
• Admin in intensive care units
• Lyse (dissolve) thrombi