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Hematologic System

Name Anticoagulants/Parenteral
Mechanism of Prevent bleeding by inactivation of thrombin formation, inhibition of
Action formation of fibrin
Therapeutic Uses Anticoagulation for purposes of stroke, PE, deep venous thrombosis,
prophylaxis for venous thrombosis, acute MI
Side Hemorrhage, thrombocytopenia (low platelet count), should not be
Effects/Precaution used for surgeries for the eye, brain, spinal cord, or lumbar puncture
Interactions Antiplatelets such as ASA, NSAIDS and other anticoagulants increase
risk of bleeding
Nursing/Patient Protamine sulfate is antidote, monitor PTT (therapeutic levels
Teaching should be 60 80sec), can be IV or SubQ,
Common Drugs Heparin, low weight heparins: enoxaparin (Lovenox)

Name Anticoagulants/ Oral

Mechanism of Antagonize vitamin K, preventing synthesis of coagulation factors
Therapeutic Uses Treatment for venous thrombosis/formation, recurrent MI, TIAs
Side Hemorrhage, hepatitis, pregnancy risk X, thrombocytopenia, vitamin
Effects/Precaution K deficiencies
Interactions Use of heparin, ASA, Tylenol, glucocorticoids, sulfonamides,
cephalosporins increase effects of warfarin.
Phenobarbital, tegrtol, dilantin, oral contraceptives decreases
anticoagulation effects.
Nursing/Patient Monitor PT levels (therapeutic level is 1.5 to 2 times control: 18 to 24
Teaching seconds), Monitor INR (2 to 3 for treatment of MI, Afib, PE,
thrombosis. 3 to 4.5 for heart valve) Vitamin K is antidote.
Common Drugs Warfarin (Coumadin)

Name Antiplatelets
Mechanism of Prevent platelets from clumping together by inhibiting enzymes and
Action factors that lead to clotting
Therapeutic Uses Prevention of acute MI, prevention of reinfarction following MI,
stroke, claudication
Side GI upset, hemorrhagic stroke, prolonged bleeding, Tinnitus (hearing
Effects/Precaution loss)
Interactions Caution with other anticoagulants, Urine acidifiers increase ASA
levels, Corticosteriods increase ASA excretion, caffeine may increase
ASA absorption,
Nursing/Patient 325mg should be taken during initial acute episode of MI,
Common Drugs ASA, clopidogrel (Plavix)
Name Thrombolytics
Mechanism of Dissolve clots that have already formed by converting plasminogen
Action to plasmin which destroys fibrinogen
Therapeutic Uses Acute MI, DVT, massive PE, ischemic stroke
Side Serious risk of bleeding, hypotension, NEVER for hemorrhagic stroke
Interactions Caution with other anticoagulants,
Nursing/Patient Obtain baseline platelet, hgb, hct, PTT, PT, INR, and fibrinogen levels
Common Drugs Streptokinase (Streptase),