Actions/Uses

Parenteral anticoagulants prevent bleeding by inactivation of thrombin formation and factor Xa, resulting inhibition of formation of fibrin.

Uses:

In conditions necessitating prompt anticoagulant activity (i.e. stroke, pulmonary embolism, massive DVT), during pregnancy adjunct for clients having open heart surgery or real dialysis 

As low-dose therapy for prophylaxis against postop venous thrombosis In disseminated intravascular coagulation 

In conjunction with thrombolytic therapy when treating an acute MI

Side Effects

Hemorrhage secondary to heparin OD

Heparin-induced thrombocytopenia, as evidenced by low platelet count and Increase development of thrombi – mediated by antibody development

Hypersensitivity reactions (e.g.: chills, fever, urticaria)

Parenteral anticoagulants are contraindicated in clients with low platelet counts (thrombocytopenia) or uncontrollable bleeding.

These medications should not be used during or following surgeries of the eyes(s), brain, or spinal cord; lumbar puncture; or regional anesthesia.

Use cautiously in clients with hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, or threatened abortion

Implications

Anti-platelet agents such as aspirin – additive risk of bleeding with concurrent use.

Obtain client’s baseline values: CBC, platelet count and hematocrit levels

Heparin cannot be absorbed by the intestinal tract and must be given by a deep subcutaneous injection or IV infusion

Heparin is dispensed in units and has different concentrations

Dosages should be checked by another nurse before administration.

For continuous IV admin, use an infusion pump.  Rate of infusion must be monitored every30-60 mins.

Monitor aPPT every 4-6 hrs until appropriate dose is determined and then monitor daily

For sub Q, use a 20 – 22 gauge needle to withdraw heparin solution form vial.  Change to a smaller needle

De sub q injections should be administered in the abdomen ensuring a distance of 2 inches from umbilicus.  Do No Aspirate. Rotate site.

Action / Uses

Oral anticoagulants antagonize vitamin K, thereby preventing the synthesis of four clotting factors: VII, IX, X and prothrombin.

Uses: Prevention of Venous thrombosis, Thrombus formation in clients with atrial fibrillation, thrombus formation in cliens with prosthetic heart valves

Side Effects

Hemorrhage – Monitor VS, Observe S&S: Bleeding, Increase HR, Decrease BP, brusing petechiaae, hematomas, black or tarry stools), Obtain baseline PT and INR, Administer Vitamin K in case of Overdose.

Don’t use if pregnant, or thrombocytopenia or uncontrollable bleeding.  Don’t used during or following surgeries especially: eye, brain or spinal cord (Lumbar puncture/regional anesthesia.)

Those with Vit K deficiencies, liver disorder and alcoholism, due to extra bleeding.

Be careful with those that have hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension or threatened abortion

Actions / Uses

Acts by dissolving clots that have already been formed.  Dissolution of clots by converting of plasminogen to plasmin which destory fibrinogen and other clotting factors

Uses: Acute MI, DVT, Massive Pulmonary emboli, Ischemic stroke (alteplase)

Side effects

Serious risk of bleeding from different sites (e.g., within brain, needle puncture sites, wounds.)

Hypotension

Allergic reaction (e.g., uticaria, itching, flushing – maybe severe anaphylactic reaction

Contraindicated for clients with any prior intracrainal hemorrhage, known structural cerebral vascular lesión.  Clients with severe hypertension.

Implications/Misc

Limit venipunctures and injections, apply pressure dressings to recent wounds, monitor the client for changes in vital signs, alteratations in LOC, weakness and signs of intercrainal bleeding, Notify PCP if symptoms occur.

Other medications that enhance bleeding don’t use.

Actions /Uses

Antiplatelet prevent platelets from clumping together by inhibiting enzymes and factors that normal lead to arterial clotting.

Primary prevention of Acute MI; Prevention of reinfarction in clients following an Acute MI; Prevention of stroke; Acute coronary syndromes (abviximam (Reo Pro), tirofiban (Aggrastat)

Actions / Uses

Treatment of excessive bleeding in hyperfibrinolysis; prevention of recurrence of subarachnoid hermorrhage; for management of megakaryocytic thrombocytopenia, to decreast the need for platelet administration and to abort or treatment in heraditary angioneurotic edema

Inhibits plasminogen activator substances and has antiplasmin activity that inhibits fibrinolysis and prevents breakdown of clots

Side Effects