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PN PHARMACOLOGY FOR NURSINGCHAPTER 22MEDICATIONS AFFECTING COAGULATION181UNIT 5MEDICATIONS AFFECTING THEHEMATOLOGIC SYSTEMCHAPTER 22MedicationsAffectingCoagulationPharmaceutical agents that modify coagulationprevent clot formation or break apart an existingclot. These medications work in the blood toalter the clotting cascade, prevent plateletaggregation, or dissolve a clot. All carry asignificant risk of bleeding.The goal of medications that alter coagulation isto increase circulation and perfusion, decreasepain, and prevent further tissue damage.These medications include oral and parenteralanticoagulants, direct thrombin inhibitors, directinhibitors of factor Xa, antiplatelet medications,and thrombolytic agents.Parenteral anticoagulantsSELECT PROTOTYPE MEDICATION:HeparinLow molecular weight heparinsSELECT PROTOTYPE MEDICATION:EnoxaparinOTHER MEDICATIONS:DalteparinActivated factor Xa inhibitorSELECT PROTOTYPE MEDICATION:FondaparinuxPURPOSEEXPECTED PHARMACOLOGICAL ACTIONHeparin prevents clotting by activating antithrombin, thusindirectly inactivating both thrombin and factor Xa. Thisinhibits fibrin formation. Enoxaparin primarily inactivatesfactor Xa and is much less able to inactivate thrombin.Fondaparinux inactivates factor Xa, thus decreasingthrombin production.THERAPEUTIC USESHeparinTreats disorders necessitating prompt anticoagulantactivity (evolving stroke, pulmonary embolism, massivedeep‑vein thrombosis [DVT])An adjunct for clients having open heart surgery orrenal dialysisAn adjunct to thrombolytic therapy for acute myocardialinfarction (MI)Low‑dose therapy for prophylaxis against postoperativevenous thrombosis (hip, knee, or abdominal surgery)Treat disseminated intravascular coagulationPreferred anticoagulant for use during pregnancyLow molecular weight heparinsPrevent DVT in clients who are postoperativeTreat DVT and pulmonary embolismPrevent complications of angina and MIActivated factor Xa inhibitor (fondaparinux)Prevent DVT and pulmonary embolism postoperativelyTreat acute DVT or pulmonary embolism in conjunctionwith warfarinCOMPLICATIONSHEPARINHemorrhage due to heparin overdoseNURSING ACTIONSMonitor vital signs.Withhold heparin. The client needs protamine IV andshould avoid other anticoagulants, including aspirin.Monitor activated partial thromboplastin time (aPTT).The usual result is 40 seconds, but a therapeuticresponse raises the aPTT by 1.5 to 2 times (60 to80 seconds).Check the aPTT every 4 to 6 hours during initial therapyand once daily thereafter.CLIENT EDUCATION:Observe for bleeding (increasedheart rate, decreased blood pressure, bruising, petechiae,hematomas, and black tarry stools).Heparin‑induced thrombocytopeniaLow platelet count and increase in thrombus formationNURSING ACTIONSMonitor platelet count periodically throughouttreatment, especially in the first month.

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Surgical Technology for the Surgical Technologist: A Positive Care Approach
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Chapter 9 / Exercise 4
Surgical Technology for the Surgical Technologist: A Positive Care Approach
Association of Surgical Technologists
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