Medications - Coagulation Modifiers (4).doc - 1 Coagulation...

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Coagulation ModifiersDrug ClassificationMedication Name Generic (Brand)Mechanism of Action & IndicationsAdverse ReactionsNursing ImplicationsAnticoagulants: Used to prevent clot extension and formation. They do not dissolve clots. Indirect thrombin: inhibitors: - Heparin (unfractionated) -LMWHs(heparin molecule has been shortened and modified---inhibition more specific to factor Xa, than thrombin)Vitamin K Antagonist: Direct thrombin inhibitors:***No antidote ---- except, dabigatran (2015).Selective factor Xa inhibitor:- Heparin -enoxaparin (Lovenox)-dalteparin (Fragmin)-tinzaparin (Innohep)-nadroparin (Fraxiparine)-warfarin (Coumadin)-desirudin (Iprivask)-SQ-lepirudin (Refludan)-IV-bivalirudin (Angiomax)-IV-argatroban (Acova)-IV-dabigatran (Pradaxa)-po-antithrombin (Thrombotic)----from human plasma donor. Antithrombin is the major natural inhibitor of thrombin in the blood.-fondaparinux (Arixtra)-SQ-rivaroxaban (Xarelto) -po -apixaban (Eliquis) – po-edoxaban (Savaysa) - poHeparins inhibit clotting factors IIa (thrombin) and Xa.-LMWH duration of action 2 – 4 times longer than that of heparin. Coumadin inhibits vitamin K synthesis by inhibiting vitamin K-dependent clotting factors II, VII, IX, and X, as well as anticoagulant proteins C and S. Direct thrombin inhibitors inhibit thrombin (factor IIa) ----they bindto active site of thrombin, preventing the formation of fibrinclots. May be used for HIT.ACT or PTT used to monitor IV or subcut direct thrombin inhibitors. -Inhibits factor Xa.Risk for bleeding (most frequent and serious) for allanticoagulants.Thrombocytopenia. Risk for HIT.LMWH less likely to cause thrombocytopenia.Do not give LMWH if patient has an epidural catheter.Diagnostic test to monitor heparin: PTTor aPTT.Heparin antidote: Protamine sulfate. -For all anticoagulants: Monitor plateletcounts.-LMWH more stable response and thus,fewer follow-up labs are needed. Protamine also antagonist to LMWHs.Coumadin diagnostic test to monitor Coumadin: INR and PT.Coumadin antidote: Vitamin K (phytonadione [AquaMephyton]) orKcentra (Prothrombin Complex Concentrate – Human.Coumadin can cause skin necrosis and “purple toes.”Warfarin takes 48 – 72 hours to affect prothrombin time and INR. Thus, usually a 5 day overlap with UH or LMWH.
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