Anticoagulant drugs alter some aspect of

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Unformatted text preview: complications Do not dissolve clots 9 Anticoagulant Drugs Anticoagulant 1. Anticoagulant drugs alter some aspect of Anticoagulant 2. 3. 4. 5. the blood coagulation process. the Anticoagulants drugs are given to prevent Anticoagulants formation of new clots and the extension of existing clots. existing Anticoagulants do not interfere with Anticoagulants existing clots. existing Anticoagulants may be classified as acting Anticoagulants either directly or indirectly on the coagulation cascade. coagulation Widely used in thrombotic disorders. 10 Types of Anticoagulant Agents 1. Parenteral Includes heparin and the low molecular Includes weight heparins weight 1. Oral Includes warfarin (Coumadin) 11 Heparin and Heparin Derivatives Derivatives Heparin (unfractionated) – Enhances antithrombin – Rapid-acting anticoagulant – Administered by injection only IV – Continuous and intermittent Deep subQ Deep 12 12 Heparin (Unfractionated) Heparin Therapeutic uses – Preferred anticoagulant during pregnancy and Preferred when rapid anticoagulancy is required when – Pulmonary embolism (PE) – Stroke evolving – Massive deep venous thrombosis (DVT) – Open-heart surgery – Renal dialysis – Low-dose therapy postoperatively – DIC – Adjunct to thrombolytic therapy 13 Heparin (Unfractionated) Heparin Adverse effects – Hemorrhage: bleeding out. Internal hemorrhage blood Hemorrhage: pressure and heart rate. Also look externally (bloody nose- can cause blood pressure to go down) cause – Heparin-induced thrombocytopenia – Hypersensitivity reactions Contraindicated (don’t give this when….) – – – Thrombocytopenia Uncontrollable bleeding During and immediately after surgery of the eye, brain, or spinal During cord- they will bleed into these areas Antidote for OD – protamine sulfate Activated partial thromboplastin time (aPTT)- lab value to Activated evalute heparin 14 14 Direct-Acting Anticoagulants Direct-Acting • High Molecular Weight Heparin Heparin Heparin • Low Molecular Weight Heparins Dalteparin (Fragmin) Enoxaparin (Lovenox) Enoxaparin • 1. 2. 3. 4. 5. Advantages of LMW Heparins: Less lab monitoring needed Less likely to cause thrombocytopenia Half life longer---permits once daily dosing Does not cross placenta DOC---post op 15 Low-Molecular-Weight Heparins Low-Molecular-Weight Heparin preparations composed of Heparin molecules that are shorter than those found in unfractionated heparin found Therapeutic uses – Prevention of DVT following surgery Including replacement of hip, knee – Treatment of established DVT – Prevention of ischemic complications Patients with unstable angina, non-Q wave MI, Patients and STEMI 16 16 Low-Molecular-Weight Heparins Low-Molecular-Weight Administered subQ Administered subQ Dosage based on body weight Antidote for toxicity – protamine sulfate Antidote Costs more than unfractionated heparin Costs Does not require monitoring; can be given at home Adverse effects and interactions – Bleeding (but less than with unfractionated heparin) – Immune-mediated thrombocytopenia – Severe neurologic injury for patients undergoing spinal puncture Severe or spinal epidural anesthesia or – Black stools- bleeding in the GI system Black – Dizziness – Pruritis – Pain at injection site 17 Warfarin, an Oral Anticoagulant Warfarin, Clinical use – Oral anticoagulant with delayed onset – Vitamin K antagonist (antidote is vitamin K) – Blocks the biosynthesis of factors VII, IX,...
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This document was uploaded on 03/25/2014.

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