CHAPTER 26.docx

CHAPTER 26 The Fibrinolytic system initiates the breakdown of clots. Hemophiliacs are at high risk of bleeding to death. Anticoagulants: Slow blood clotting Prevent clot formation Examples are Heparin and Warfarin Antiplatelets: Keep blood clots from forming by keeping platelets from sticking togeth...

CHAPTER 26 The Fibrinolytic system initiates the breakdown of clots. Hemophiliacs are at high risk of bleeding to death. Anticoagulants: Slow blood clotting Prevent clot formation Examples are Heparin and Warfarin Antiplatelets: Keep blood clots from forming by keeping platelets from sticking together Prevent platelet plugs Examples are Aspirin, Clopidogrel, and Ticagrelor Hemorheologic drugs – alter platelet function without preventing the platelets from working. Thrombolytic drugs – break down (lyse) existing clots Antifibrinolytic or hemostatic – promote blood coagulation Two types of Heparin – Unfractionated heparin and Low Molecular weight heparin Unfractionated Heparin is derived from Porcine sources and is given via IV or Subcutaneously. Low Molecular weight heparin is synthetic and is given subcutaneously. The labs we would need to frequently draw for a patient on unfractionated heparin is aPTT which monitors for bleeding. With LMWH heparins, you do not need to monitor their aPTT frequently. Two LMWH heparins are Enoxaparin/Lovenox and Dalteparin/Fragmin. We want to educate patients who are taking warfarin on safe administration, prevention and management of bleeding, and when to contact doctor. Side effects of warfarin include: Petechiae Ecchymosis/bruising Bleeding gums Blood in stools Hematemesis/bloody vomit Uncontrollable internal bleeding from falls or minor trauma Heparin-induced Thrombocytopenia is a complication caused by heparin that causes decreased platelets in the blood. With HIT you will be checking platelet levels because it causes low platelets. With type 1 HIT, you will have a gradual reduction in platelets and can continue heparin therapy. With type 2 HIT, you will see an acute fall of over 50% from baseline of platelets and need to discontinue heparin. Treatment for HIT is thrombin inhibitors Lepirudin and Argatroban. The antidote for Heparin is IV protamine sulfate. The antidote to Warfarin is Vitamin K. To monitor the Vitamin K, we will have to monitor INR labs. Aspirin prevents platelet adhesion; it is used for antiplatelet purposes. We do bridge therapy to make sure that patients have adequate levels of medication in their system from PO before being sent home without IV.