- action: disrupt the blood coagulation process, thereby suppressing the production of fibrin
- examples
- heparin: parenteral administration
- coumadin (Warfarin): oral administration
- use
- pulmonary embolism
- deep vein thrombosis
- myocardial infarction
- atrial fibrillation
- adverse side effects
- allergic responses such as chills, fever and urticaria
- use cautiously if client tends to bleed (hemophilia, peptic ulcer)
- GI disturbances- nausea and vomiting, diarrhea, abdominal cramps
- contraindications
- hemophilia
- leukemia
- peptic ulcer
- blood dyscrasias
- nursing interventions
- heparin: monitor APTT (activated partial thromboplastin time)
- normal 40 seconds
- at therapeutic levels, APTT increases by a factor of 1.5 to 2
- coumadin – monitor PT (prothrombin time)
- normal 12 seconds
- INR (International normalized ratio) two to three
- do baseline blood studies before therapy
- have antidote ready
- heparin: protamine sulfate
- coumadin: vitamin K
- monitor client for symptoms of hemorrhage such as increased pulse, decreased BP
- avoid salicylates (such as aspirin)
- avoid IM injections
- teach client
- take medication at same time every day
- wear medical alert jewelry: wearer takes anticoagulants (illustration
)
- use a soft toothbrush
- do not use a straight razor; use an electric razor
- avoid alcohol and smoking
- report any signs of bleeding, red or black bowel movements, headaches, rashes, red or pink-tinged urine, sputum
- avoid trauma
- blood levels of the anticoagulant may be monitored
- do not take over-the-counter (OTC) medications without health care provider’s approval
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