Anti-coagulants

jaccimv · Feb 23, 2009

Before I give lovenox I always check my pts platelet level, our hospital requires that it is checked at least every three days if not already drawn.

Virgo_RN, BSN, RN · Feb 23, 2009

INR is for Coumadin, aPTT is for heparin. We check ACT if the patient had Angiomax. For LMWH, I check platelets before giving.

John H Miller · Aug 6, 2010

Help! I am not a nurse nor a doctor nor a medical professional at all. I have been taking care of my father for about five months because he keeps falling. He is scheduled for knee replacement surgery on Monday, so his doctor took him off Coumadin (he was on 5.0mg daily) and switched him to Lovenox (120mg injections) as a bridge until surgery. She also ordered a daily PT and INR to monitor his blood (his INR has gone from 2.5 four days ago to 1.6 today). From this posting I understand Lovenox does not affect his PT and INR. I am concerned because he has been bleeding "like a stuck pig" (for lack of a better expression...keep in mind I am not a medical professional) since switching to Lovenox because he keeps bumping into things and it tears his already fragile skin. His blood IS clotting but he did not tear his skin so easily when he was on Coumadin. His INR on 5mg Coumadin was 2.48 (he went off it four days ago) and everything seemed to be okay. Am I over-reacting? Is he going to be okay going into surgery on Monday? I don't want him bleeding to death. I've also read that when a patient is on Lovenox, they should instead be doing an Activate Clotting Time (ACT) or a Thromboelastogram (TEG), although the former is preferred. Should I insist they do this? If so, how often? His doctor is out on vacation this week and so is her nursing assistant. I've called the office of the surgeon who is performing the surgery on Monday and he is deferring to my father's primary physician. If someone is reading this, please respond. Remember, I am NOT a medical professional (I had BIO 101 in college and that's it!) so please keep it simple and do not be afraid of insulting my intelligence. It may sound like I know what I'm talking about, but I don't, even though I have to admit that, after taking care of my father for five months, I'm tempted to apply for med school and go into gerontology! Just kidding...please let me know if I'm off base on this one. Thanks.

highlandlass1592, BSN, RN · Aug 6, 2010

Help! I am not a nurse nor a doctor nor a medical professional at all. I have been taking care of my father for about five months because he keeps falling. He is scheduled for knee replacement surgery on Monday, so his doctor took him off Coumadin (he was on 5.0mg daily) and switched him to Lovenox (120mg injections) as a bridge until surgery. She also ordered a daily PT and INR to monitor his blood (his INR has gone from 2.5 four days ago to 1.6 today). From this posting I understand Lovenox does not affect his PT and INR. I am concerned because he has been bleeding "like a stuck pig" (for lack of a better expression...keep in mind I am not a medical professional) since switching to Lovenox because he keeps bumping into things and it tears his already fragile skin. His blood IS clotting but he did not tear his skin so easily when he was on Coumadin. His INR on 5mg Coumadin was 2.48 (he went off it four days ago) and everything seemed to be okay. Am I over-reacting? Is he going to be okay going into surgery on Monday? I don't want him bleeding to death. I've also read that when a patient is on Lovenox, they should instead be doing an Activate Clotting Time (ACT) or a Thromboelastogram (TEG), although the former is preferred. Should I insist they do this? If so, how often? His doctor is out on vacation this week and so is her nursing assistant. I've called the office of the surgeon who is performing the surgery on Monday and he is deferring to my father's primary physician. If someone is reading this, please respond. Remember, I am NOT a medical professional (I had BIO 101 in college and that's it!) so please keep it simple and do not be afraid of insulting my intelligence. It may sound like I know what I'm talking about, but I don't, even though I have to admit that, after taking care of my father for five months, I'm tempted to apply for med school and go into gerontology! Just kidding...please let me know if I'm off base on this one. Thanks.

I'd say first of all..take a deep breath. It's going to be ok. :-) We can't offer medical advice here but I can give you a bit of background on anti-coagulation.

Taking someone off Coumadin is pretty common before surgery. (We do that with our pre-op heart patients.) They aren't monitoring the PT & INR now to check on the Lovenox but to make sure the INR comes down to an acceptable level before surgery takes place. You don't want someone going to surgery to have a preventable bleeding issue. As for the bleeding you mentioned, pt's who take Coumadin may have issues regarding bleeding when they are theraputic (meaning their INR is at goal level)....even a simple scratch can take quite a bit of time to stop bleeding.

You asked about an ACT: ACT's aren't done to monitor pt's on Lovenox, they are used for other types of anti-coagulation when pt's are in the hospital...so no, I wouldn't insist on getting an ACT done, it's not going to affect the care your father needs.

Actually, you spoke about calling the surgeon's office...I'd actually recommend you speak with your local pharmacist. They would probably have a better understanding of your father's situation as to why he's taking Coumadin and he can give you pt education handouts talking about Lovenox and issues to watch for. Pharmacists are a wealth of information..don't be afraid to utilize them.

Good luck to you and your father..hope his surgery goes well.