Anticoagulants

Anticoagulants


Action: Anticoagulants interfere with blood clotting by preventing clot formation.

Uses: Anticoagulants are used for deep vein thrombosis, pulmonary emboli, myocardial infarction, open-heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with embolization, transfusion, and dialysis.

Side effects / Adverse reactions: The most serious adverse reactions are hemorrhage, agranulocytosis, leukopenia, eosinophilia, and thrombocytopenia, depending on the specific product. The most common side effects are diarrhea, rash, and fever.

Contraindications: Persons with hemophilia and related disorders, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, blood dyscrasias, acute nephritis, and subacute bacterial endocarditis should not use these products.

Precautions: Anticoagulants should be used with caution in alcoholism, elderly, and pregnancy.

Interactions: Salicylates, steroids, and non-steroidal antiinflammatories will potentiate the action of anticoagulants. Anticoagulants may cause serious effects; please check individual monographs.

Possible nursing diagnoses:
» Altered tissue perfusion [uses]
» Risk for injury [side effects]
» Knowledge deficit [teaching]

Nursing Considerations


Assess:
» Blood studies (Hct, platelets, occult blood in stools) q3mo
» Partial prothrombin time, which should be 1 1/2 – 2 x control PPT qd, also APTT, ACT
» B/P, watch for increasing signs of hypertension
» Bleeding gums, petechiae, ecchymosis; black, tarry stools; hematuria
» Fever, skin resh, urticaria
» Needed storage change q1-2wk

Administer:
» At same time each day to maintain steady blood levels
» Do not massage area or aspirate when giving SC injection; give in abdomen between pelvic bone, rotate sites; do not pull back on plunger; leave in for 10 seconds; apply gentle pressure for 1 minute
» Without changing needles
» Avoiding all IM injections that may cause bleeding

Perform/Provide:
» Storage in tight container

Evaluate:
» Therapeutic response: decrease in deep vein thrombosis

Teach patient/family:
» To avoid OTC preparations that may cause serious drug interactions unless directed by prescriber
» That drug may be held during active bleeding (menstruation), depending on condition
» To use soft bristle toothbrush to avoid bleeding gums, avoid contact sports, use electric razor
» To carry emergency ID identifying drug taken
» To report any signs of bleeding: gums, under skin, urine, stools

Selected Generic Names


Ardeparin
Argatroban
Dalteparin
Danaparoid
Desirudin
Enoxaparin
Fondaparinux
Heparin
Lepirudin
Tinzaparin
Warfarin

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