Drugs Used to Treat Thromboembolic Disorders

Chapter 27Chapter 27

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Chapter 27

Lesson 27.1

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ObjectivesObjectives

• Describe conditions that place an individual at risk for developing blood clots

• Analyze Figure 27-1 to identify the site of action of warfarin, heparin, and fibrinolytic agents

• State the primary purposes of anticoagulant therapy

• Identify the effects of anticoagulant therapy on existing blood clots

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Objectives (cont’d)Objectives (cont’d)

• Explain laboratory data used to establish dosing of anticoagulant medications

• Describe procedures used to ensure that the correct dose of an anticoagulant is prepared and administered

• Identify specific nursing interventions that can prevent clot formation

• Develop objectives for patient education for patients receiving anticoagulant therapy

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Thromboembolic DiseasesThromboembolic Diseases

• Include the process of forming a blood clot or thrombus

• Fragments of a thrombus can break off and circulate until trapped in a capillary, creating an embolus

• Clotting cascade is activated when a blood vessel is injured, or with increased viscosity

• Intrinsic clotting pathway• Extrinsic clotting pathway

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Nonpharmacologic Treatment Nonpharmacologic Treatment of Thromboembolic Diseasesof Thromboembolic Diseases

• Prevention of conditions that cause clots to form Immobilization with venous stasis Surgery, trauma to lower limbs Heart failure, vasospasm Cancers of the lung, prostate, stomach, pancreas Pregnancy, oral contraceptives

• Ways to prevent stasis: leg exercises, wearing stockings, leg elevation, sequential compression devices

• Revascularization treatments: percutaneous coronary intervention, coronary artery bypass graft

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Drug Therapy Goals Drug Therapy Goals for Thromboembolic Diseasesfor Thromboembolic Diseases

• Primary purpose is to prevent platelet aggregation or inhibit steps in the clotting cascade

• Four types of agents Platelet inhibitors Anticoagulants Glycoprotein IIb/IIIa inhibitors Thrombolytics

• Anticoagulation therapy prevents new clot formation or extension of existing clots

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Laboratory Tests Laboratory Tests for Thromboembolic Diseasesfor Thromboembolic Diseases

• Coagulation tests PT (prothrombin time) aPTT (activated partial thromboplastin time) INR (international normalized ratio) Platelet counts

• Diagnostic tests PT, aPTT, hematocrit, platelet count, Doppler

studies, exercise testing, serum triglycerides, arteriogram, cardiac enzyme studies

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Correct DosingCorrect Dosing

• Key in the treatment of conditions used to control clots

• Use medication administration record for scheduling

• Mark one-time dosages clearly• Never administer anticoagulants before first

checking the chart for most recent laboratory results

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Patient Education Patient Education for Anticoagulation Therapyfor Anticoagulation Therapy

• Diet and nutrition Limit intake of leafy green vegetables Drink six to eight 8-ounce glasses of fluid daily

• Exercise and activity after surgery to prevent venous stasis

• Do not flex knees or place pressure under knees; avoid being motionless

• Medication regimen Dose and timing, common and serious

adverse effects, drug interactions

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The Clotting CascadeThe Clotting Cascade

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Chapter 27

Lesson 27.2

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ObjectivesObjectives

• State the nursing assessments needed to monitor therapeutic response and development of common and serious adverse effects from anticoagulant therapy

• Explain the specific procedures and techniques used to administer heparin subcutaneously, via intermittent administration through a heparin lock, and via IV infusion

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Objectives (cont’d)Objectives (cont’d)

• Identify the purpose, dosing determination, and scheduling factors associated with the use of protamine sulfate

• Describe specific monitoring procedures to detect hemorrhage in the patient taking anticoagulants

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Drug Class: Platelet InhibitorsDrug Class: Platelet Inhibitors

• Actions Inhibit platelet aggregation

• Uses Primary prevention of MIs and stroke; prevent

blood clots from forming

• Common adverse effects Abdominal distress, hypotension

• Serious adverse effects Neutropenia, agranulocytosis, bleeding

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Drug Class: AnticoagulantsDrug Class: Anticoagulants

• Actions Low molecular weight heparin (LMWH)

• Uses Prevent deep vein thrombosis after hip

replacements or abdominal surgery; prevent MIs, combined with aspirin

• Common adverse effects Hematoma formation, bleeding at injection site

• Serious adverse effects Bleeding, thrombocytopenia

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Drug Class: AnticoagulantsDrug Class: Anticoagulants

• Drug: heparin • Actions

In the presence of heparin, antithrombin III neutralizes thrombin, factors IXa, Xa, XI, and XII, as well as plasmin

• Uses Treat deep vein thrombosis, pulmonary

embolism, cerebral embolism• Can be given subcutaneously, IV push, IV

infusion• Dosages vary depending on route• Monitor aPPT, platelets, hematocrit

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Assessment for BleedingAssessment for Bleeding

• Monitor to detect hemorrhage• Symptoms of internal bleeding

Decreased blood pressure, increased pulse, cold clammy skin, faintness, disorientation

• Consider all areas of the body that could begin to bleed (visible and internal)

• Monitor laboratory values aPPT, platelets, hematocrit

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Drug Class: Drug Class: Glycoprotein IIb/IIIa InhibitorsGlycoprotein IIb/IIIa Inhibitors

• Drugs: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat)

• Actions Block receptors on platelets, preventing

aggregation and clot formation

• Uses Prevent clots forming from the debris often

released during percutaneous coronary intervention (PCI) procedures

• Serious adverse effects Bleeding, thrombocytopenia

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Drug Class: Fibrinolytic AgentsDrug Class: Fibrinolytic Agents

• Drugs: streptokinase, alteplase (Activase), reteplase (Retavase), tenecteplase (TNKase)

• Actions Stimulate the bodies own clot-dissolving

mechanism, converting plasminogen to plasmin, which digests fibrin

• Uses Dissolve fibrin clots secondary to coronary

artery occlusion (MI), pulmonary emboli, cerebral emboli, deep venous thrombosis

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