Anticoagulants

1. action: disrupt the blood coagulation process, thereby suppressing the production of fibrin
2. examples

• 1. heparin: parenteral administration
• 2. coumadin (Warfarin): oral administration

3. use

• 1. pulmonary embolism
• 2. deep vein thrombosis
• 3. myocardial infarction
• 4. atrial fibrillation

4. adverse side effects

• 1. allergic responses such as chills, fever and urticaria
• 2. use cautiously if client tends to bleed (hemophilia, peptic ulcer)
• 3. GI disturbances- nausea and vomiting, diarrhea, abdominal cramps

5. contraindications

• 1. hemophilia
• 2. leukemia
• 3. peptic ulcer
• 4. blood dyscrasias

6. nursing interventions
1. heparin: monitor APTT (activated partial thromboplastin time)
* normal 40 seconds
* at therapeutic levels, APTT increases by a factor of 1.5 to 2
2. coumadin - monitor PT (prothrombin time)
* normal 12 seconds
* INR (International normalized ratio) two to three
3. do baseline blood studies before therapy
4. have antidote ready
* heparin: protamine sulfate
* coumadin: vitamin K
5. monitor client for symptoms of hemorrhage such as increased pulse, decreased BP
6. avoid salicylates (such as aspirin)
7. avoid IM injections
8. 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