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Heparin sodium (Hepalean, Hep-Lock)
Indications: Administered parenterally (SQ or IV) as am antagonist to thrombin and to prevent the conversion of fibrinogen to fibrin
Adverse reaction: hemorrhage, agranulocytosis, leukopenia, hepatitis, heparin-induced thrombocytopenia
Nursing implication:
- assess PTT, Hgb, Hct, platelets
- assess stools for occult blood
- avoid IM injection
- notify anyone performing diagnostic testing of medication
- Antagonist: protamine sulfate
Warfarin sodium (Coumadin, Coumnarin, Panwarfin)
Indications: blocks the formation of prothrombin from vitamin K
adverse reaction: hemorrhage, agranulocytosis, leukopenia, hepatitis
Nursing implication: see heparin
- give orally and assese PT
- avoid sudden change in intake of foods high in vitamin K
- antagonist: vitamin k
Antiplatelet Agents:
- Ticlopidine (Ticlid)
- Dipyridamole (Persantine)
- Clopidogrel (Plavix)
- Prasugrel (Efficent)
- Ticagrelor (Brilinta)
Indication:
- short term use after cardiac interventiond
- reduce risk for thrombolytic sroke for those intolerant to aspirin
- prevention of thrombolytic disorder
Adverse reaction: neutropenia, thrombocytopenia, agranulocytosis, leukopenia, hemorrhage, GI irritation, bleeding, pancytopenia
- Give PC or with food to decrease gastric irritation (Ticlid)
- Advise not to take antacids within 2 hours of taking ticlopidine
- Monitor CBC every 2 week for 3 months, and thereafter if signs of infection develops
- Monitor for signs of bleeding
- Give 1 hour of AC (Persantine); (Plavix) no regard for meals
Low-Molecular - Weight Heparins
- Enoxaparin (Lovenox)
- Tinzaparin (Innohep)
- Dalteparin (Fragmin)
Indication: Prevention of thrombolytic formation (deep vein)
Adverse reaction: hemorrhage, GI irritation, bleeding, thrombocytopenia
Nursing Implication: monitor for sign of bleeding, give SQ, monitor CBC, use soft toothbrush, avoid cuts
Factor Xa Inhibitor
- Fondaparinux
Adverse reaction: hemorrhage, GI irritation, bleeding
Group IIa-IIb Inhibitor (Platelet Antiaggregant)
- Eptifibatide (Integrilin)
- Tirofiban (Aggrastat)
- Abciximab (ReoPro)
- acute coronary syndrome (unstable angina or non-Q wave MI)
- used in combination with heparin, aspirin, and, in selected situation, Ticlid and Plavix
Adverse Reaction:
- bleeding, most frequent
- hypotension, thrombocytopenia
- acute toxicity: decreased muscle tone, dyspnea, loss of righting reflex
- check drug-drug interactions before giving other medications
- obtain baseline PT/PTT, Hgb, Hct, and platelet count, and monitor
- dose adjusted by weight for older adults
- same client teaching as with heparin; review activities to avoid
- watch for bleeding
- quickly reversible, so emergency procedures may still be performed shortly after discontinuing infusion
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