Anticoagulants

Front 1

- Inhibits formation of new clots. High molecular weight mucopolysaccharide with rapid anticoagulant effect. Does not lyse already existing thrombi but may prevent their extension and propagation.

Back 1

Heparin

Front 2

• Lab tests: Baseline blood coagulation tests, Hct, Hgb, RBC, and platelet counts prior to initiation of therapy and at regular intervals throughout therapy.
• Note: In general, dosage is adjusted to keep APTT between 1.5–2.5 times normal control level.
• Draw blood for coagulation test 30 min b4 each SC or intermittent IV dose and q4h for pt receiving med through continuous IV during dosage adjustment period. After dosage is established, tests may be done once daily.
• Patients vary widely in their reaction to; risk of hemorrhage appears greatest in women, all patients >60 y, and patients with liver disease or renal insufficiency.
• Monitor vital signs. Report fever, drop in BP, rapid pulse, and other S&S of hemorrhage.
• Observe all needle sites daily for hematoma and signs of inflammation (swelling, heat, redness, pain).
• Antidote: Have on hand protamine sulfate (1% solution), specific heparin antagonist.
Patient & Family Education
• Protect from injury and notify physician of pink, red, dark brown, or cloudy urine; red or dark brown vomitus; red or black stools; bleeding gums or oral mucosa; ecchymoses, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness.
• Note: Menstruation may be somewhat increased and prolonged; usually, this is not a contraindication to continued therapy if bleeding is not excessive.
• Learn correct technique for SC administration if discharged from hospital on heparin.
• Engage in normal activities such as shaving with a safety razor in the absence of a low platelet (thrombocyte) count. Usually, heparin does not affect bleeding time.
• Caution: Smoking and alcohol consumption may alter response to medand are not advised.
• Do not take aspirin or any other OTC medication without physician's approval.

Back 2

Heparin

Front 3

- Deters further extension of existing thrombi and prevents new clots from forming. Has no effect on already synthesized circulating coagulation factors or on circulating thrombi.

Back 3

Warfarin Sodium (Coumadin)

Front 4

• Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage is established.
• Obtain a CAREFUL medication history prior to start of therapy. extremely IMPORTANT since many drugs interfere with the activity of anticoagulant drugs(e.g. acetaminophen, aspirin, erthromycin, glucgons...)
• Adjust dose to maintain PT at 1.5–2.5 times the control (12–15 sec), or 15–35% of normal prothrombin activity, or an INR of 2–4 depending on diagnosis.
• Lab tests: For maintenance dosage, PT/INR determinations at 1–4-wk intervals depending on patient's response; periodic urinalyses, stool guaiac, and liver function tests. Blood samples should be drawn at 12–18 h after last dose (optimum).
• Monitor closely older adult, psychotic, or alcoholic patients because they present serious noncompliance problems.
• Note: Patients at greatest risk of hemorrhage include those whose PT/INR are difficult to regulate, who have an aortic valve prosthesis, who are receiving long-term anticoagulant therapy, and older adult and debilitated patients.
Patient & Family Education
• Understand that bleeding can occur even though PT/INR are within therapeutic range. Stop drug and notify physician immediately if bleeding or signs of bleeding appear: Blood in urine, bright red or black tarry stools, vomiting of blood, bleeding with tooth brushing, blue or purple spots on skin or mucous membrane, round pinpoint purplish red spots (often occur in ankle areas), nosebleed, bloody sputum; chest pain; abdominal or lumbar pain or swelling, profuse menstrual bleeding, pelvic pain; severe or continuous headache, faintness or dizziness; prolonged oozing from any minor injury (e.g., nicks from shaving).
• Stop drug and report immediately any symptoms of hepatitis (dark urine, itchy skin, jaundice, abdominal pain, light stools) or hypersensitivity reaction (see Appendix F).
• Avoid brand interchange, take drug at same time each day, and do NOT alter dose.
• Notify physician if there is an unusual increase in menstrual bleeding (slightly increased or prolonged). Note: PT/INR are checked at least monthly in menstruating women.
• Risk of bleeding is increased for up to 1 mo after receiving the influenza vaccine.
• Fever, prolonged hot weather, malnutrition, and diarrhea lengthen PT/INR (enhanced anticoagulant effect).
• A high-fat diet, sudden increase in vitamin K–rich foods (cabbage, cauliflower, broccoli, asparagus, lettuce, turnip greens, onions, spinach, kale, fish, liver), coffee or green tea (caffeine), or by tube feedings with high vitamin K content shorten PT/INR.
• Maintain a well-balanced diet and avoid excess intake of alcohol.
• Inform dentist or any new physician about anticoagulant therapy and duration of treatment.
• Use a soft toothbrush and floss teeth gently with waxed floss.
• Use barrier contraceptive measures; if you become pregnant while on anticoagulant therapy the fetus is at great potential risk of congenital malformations.
• Do not take any other prescription or OTC drug unless specifically approved by physician or pharmacist. Carry medical identification at all times. It needs to indicate medical diagnosis, medication(s), physician's name, address, and telephone number.

Back 4

Warfarin sodium (çoumadin)

Front 5

Therapeutic range of Heparin ?

Back 5

APTT btw 1.5 - 2.5 times normal control level

Front 6

Therapeutic range of Heparin ?

Back 6

APTT btw 1.5 - 2.5 times normal control level

Front 7

Therapeutic range of Warfarin Sodium (Coumadin)

Back 7

PT 1.5-2.5 times the control (12-15 sec) or INR 2-4 depending on dx or 15-35% normal prothrombin activity.

Front 8

protamine sulfate (1% solution) is Antidote for ?

Back 8

Heparin

Front 9

protamine sulfate (1% solution) is Antidote for ?

Back 9

Heparin

Front 10

Vitamin K is antidote for?

Back 10

Warfarin Sodium

Front 11

Vitamin K is antidote for?

Back 11

Warfarin Sodium