Anti-coagulants

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    I am a graduating student nurse (this May)...We have a test tomorrow...we need to know the pt, ptt and INR normals and theraputic levels. I am getting conflicting information regarding which tests you watch with Lovenox...do you monitor pTT and INR...Could someone please clarify this for me, before I go crazy!!!
    Thanks
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  5. 4
    Quote from HARLEYBEAR
    I am a graduating student nurse (this May)...We have a test tomorrow...we need to know the pt, ptt and INR normals and theraputic levels. I am getting conflicting information regarding which tests you watch with Lovenox...do you monitor pTT and INR...Could someone please clarify this for me, before I go crazy!!!
    Thanks
    Lovenox is a low-molecular weight heparin; it has a longer half-life and and bleeding is less likely than with heparin. PTT and aPTT are used to monitor heparin therapy. However, one of the reasons Lovenox is able to be administered at home (heparin requires hospitalization) is because aPTT monitoring is not necessary (LMWH overdose is rare).

    PT and INR are for Coumadin.
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    If you want to measure the effects of lovenox, the most common methods include obtaining an activated clotting time (ACT), a thromboelastogram (TEG), or an anti-Xa level. ACT is the most practical and cheapest.
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    Quote from iteachob
    Lovenox is a low-molecular weight heparin; it has a longer half-life and and bleeding is less likely than with heparin. PTT and aPTT are used to monitor heparin therapy. However, one of the reasons Lovenox is able to be administered at home (heparin requires hospitalization) is because aPTT monitoring is not necessary (LMWH overdose is rare).

    PT and INR are for Coumadin.
    Thanks for sharing. Are any of these levels (APTT, PT, INR) measured while taking Lovenox?
    lilrednecknurse and HARLEYBEAR like this.
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    Thanks for your responses....but what tests are measured while on Lovenox...just ptt?
    pagandeva2000 likes this.
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    You don't usually monitor any test while on lovenox. You will sometimes find they run a PTT for a comparison to baseline but if you really want to monitor a lab (when I did homecare, none of our physicians ever did) you'd probably run the anti-Xa level. For all the years I've seen it used, I've never seen routine testing ordered.
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    Quote from HARLEYBEAR
    Thanks for your responses....but what tests are measured while on Lovenox...just ptt?
    I just looked in my drug book and it says to monitor PT and INR.
  11. 2
    Quote from pagandeva2000
    Thanks for sharing. Are any of these levels (APTT, PT, INR) measured while taking Lovenox?
    Not usually...I've posted a link about lovenox facts here: http://www.aahcp.org/dvt/faqs.htm Pretty much squares with what I've seen when I did homecare. We use lovenox now (at the job I'm at) for bridging patients off coumadin for surgery prep...and this is pretty much the info we use for that too. Hope it helps.
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    Quote from pagandeva2000
    I just looked in my drug book and it says to monitor PT and INR.
    Unfortunately, the way lovenox acts affects the factor Xa..which the PT, INR will give you no indication of. Which is why you'd check the anti-Xa factor. I'm not really sure why your drug book says to monitor the PT, since the lovenox wouldn't affect those values. I'm guessing it's just part of keeping on an eye on coags in general when on any form of anti-coagulation. If the INR goes crazy, it may lead us to (in some pt's) work them for hematological disorders. Truth be told, any patient on anti-coag therapy should also have at least a weekly CBCP (cbc with platelets) ordered to monitor for thrombocytopenia.
    pagandeva2000 likes this.
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    Quote from highlandlass1592
    Unfortunately, the way lovenox acts affects the factor Xa..which the PT, INR will give you no indication of. Which is why you'd check the anti-Xa factor. I'm not really sure why your drug book says to monitor the PT, since the lovenox wouldn't affect those values. I'm guessing it's just part of keeping on an eye on coags in general when on any form of anti-coagulation. If the INR goes crazy, it may lead us to (in some pt's) work them for hematological disorders. Truth be told, any patient on anti-coag therapy should also have at least a weekly CBCP (cbc with platelets) ordered to monitor for thrombocytopenia.
    Again, I thank you for sharing your information. One of the things that annoys me with these drug books is that I noticed that their information does not always collaborate. I just searched another drug guide that states to monitor CBC and platelet counts, and these guides are only two years apart (different companies, though).


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