1. Coagulation Modifier Agents Lilley Pharmacology Text: Chapter 26 Original Text modified by: Anita A. Kovalsky, R.N., M.N.Ed. Professor of Nursing Original PPT by: Professor Pat Woodbery, ARNP Professor of Nursing

2. What is Hemostasis?????
A complex process that stops bleeding after injury to a blood vessel…it involves a complex interaction of substances which:
Promotes clot formation (Thrombogenesis) and substances that either inhibit coagulation or dissolve the formed clot (Thrombolysis)

3. In other words…….. Thrombotic Disorders occur most often!!!!
Thrombi are constantly being formed………...
When balance between thrombogenesis and thrombolysis is upset, either thrombotic OR bleeding disorders occur!
Thrombotic Disorders occur most often!!!!

4. What Upsets the Balance between Thrombogenesis and Thrombolysis???
Atherosclerosis
Immobility (particularly after surgery)
Dysrhythmias (Atrial Fibrillation)
Artificial Heart Valves
These clients require prophylactic anticoagulation or……

5. A Thromboembolic Event May Occur…
Thrombophlebitis
Deep vein thrombosis (DVT)
Myocardial Infarction (MI)
Pulmonary Embolus (PE)
Cerebrovascular Accident (CVA)

6. Coagulation Modifiers: Categories and Agents (Lilley pg
Coagulation Modifiers: Categories and Agents (Lilley pg Table 26-1)
PREVENT CLOT FORMATION
Anticoagulants
Antiplatelet Drugs
REVERSAL AGENTS
(HEMOSTATIC AGENTS)
Heparin antagonist (Protamine sulfate)
Warfarin sodium antagonist (Vitamin K)

7. Prototype Anticoagulants (Trade name in parentheses) (Lilley pg
Prototype Anticoagulants (Trade name in parentheses) (Lilley pg. 415; Syllabus pg.41)
Heparin
(SQ or IV)
Half-life 1-2 hrs
Enoxaparin (Lovenox)
(SQ)
Half-life 4.5 hrs
Warfarin (Coumadin)
(PO)
Half-life days

8. HEPARIN Turns off 3 main activating factors: II (thrombin) IX X
And to a lesser extent XI & XII

9. ENOXAPRIN (LOVENOX) A low molecular weight heparin (LMWH) which is more predictable
More specific for turning off activating factors: X
And to a lesser extent II (thrombin)

10. WARFARIN (COUMADIN) More specific for turning off activating factors:II
VII IX X
These factors rely heavily on Vitamin K for synthesis, so Warfarin works by interfering with proper production of Vitamin K

12. Lab Work for Therapeutic Regulation of Anticoagulant Medications (Cavenaugh pp. 49-52)
aPTT (1.5 –2.0 x control) = Heparin
(Activated Partial Thromboplastin Time)
INR ( seconds for oral anticoagulation = Warfarin
(International Normalized Ratio)
PT ( x control) = Warfarin
(Prothrombin Time)

13. Systemic Hemostatic Agents (Lilley pg. 413; Syllabus pg.41)
Heparin Antagonist: Protamine Sulfate reverses Heparin
Coumadin Antagonist: Vitamin K (phytonadione or AquaMEPHYTON) reverses Coumadin

14. NURSING ACTIONS FOR HEPARIN AND ORAL ANTICOAGULANTS (Lilley pp
Rationale for drug
Correct dose
Site assessment
Check labs for therapeutic effects
Monitor for adverse effects

15. ANTICOAGULANT PATIENT TEACHING (Lilley pp. 414 & 430)
Increase risk of BLEEDING: avoid trauma
Periodic blood tests for Coumadin Therapy
Note OTC medications
Note diet

16. Prototype Antiplatelet Agents (Trade name in parentheses) (Lilley pg
Prototype Antiplatelet Agents (Trade name in parentheses) (Lilley pg. 419; Syllabus pg.41)
Acetylsalicylic Acid (Aspirin)
Clopidogrel (Plavix)

17. ANTIPLATELET PATIENT TEACHING (Lilley pg. 430)
Increase risk of BLEEDING: avoid trauma
ASA precautions
No ETOH or cigarette smoking
Note timing of antacids
Note diet

18. THE END