Heparine, Lovenox, Coumadin... which one?

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    Just starting Nursing school.... I am looking up all my meds on my patient. I notice that almost everyone is on some kind of blood thinner, anticoagulant ....

    Can someone please explain simply what the difference i between Heparine, Coumadin and Lovenox. And what would warrent the choice for which one. I am having a hard time finding the difference and when to use on what kind of Patient.

    Thanks
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    I am a CMA at a hem/Onc clinic. For the most part what I have seen is heparin is used mainly for emergency situations and maintaining central lines. Lovenox and Arixtra are often perscribed to raise INR in someone who has rescently had a DVT,PE,etc to raise the INR to therapeutic levels and then they are switched to coumadin. Where as coumadin is often used for long term use more than the previous drugs.

    I don't know all about these but this what I have seen in our clinic, there may be other uses, reasons, etc for choosing one ovwer the other.
    CaLLaCoDe likes this.
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    Lovenox has no effect on a pt's INR. I would suggest you consult a drug reference, a pharmacology guide, and maybe a physiology book - clotting cascade and platelet plugging. Also look up aspirin and plavix. Oh, TPA and activase to round it out. Maybe make a table to compare and contrast these.
    Last edit by AggieNurse99 on Feb 16, '10 : Reason: spelling
    Tait likes this.
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    Heparin is used during the acute phase of an MI. It can also be used for plain ole chest pain in absence of elevated cardaic enzymes. It is an emergency drug and is just frequently in EDs, ICUs, and on tele floors.

    Lovenox is given for DVTs, PEs, and often times post-op. Also used in pregnancy as it does not cross the placenta. Generally it is used for a longer time period then heparin, but not as long-term as coumadin. It is a good drug to use in the hospital or in LTCs. Home use of Lovenox is a litttle tricker since you have to have insurance authorization (at least in my area) to send a patient home on this. It is expensive and you have to teach how to self administer.

    Coumadin is used for a number of reasons long-term. Cardiac patients with A-fib, stents, or a hypercoaguable state use Coumadin. You do have to monitor the INR closely though. You have to be careful of vitamin K consumption as well. Coumadin is a bit easier to manage at home than Lovenox and is cheaper.

    Remember..
    Heparin= PTT
    Coumadin= INR
    snowflakeprincess and CaLLaCoDe like this.
  7. 2
    This can be very interesting topic so I will start from the beginning " So God said let it be and it was" LOL .. we all have cascading steps before we make clott. This is good because otherwise we will very fast step six feet under.. So, when we are under the stress god said , ( I like to joke with this God said because by love of mother earth I do not know how else do explain it - Darwin just does not help here) , so He said let us clot because if someone hurt you you need to stop bleeding. That's why we hit clots in hospitals from time to time ( there are other reasons also but this one is kind of most common) . So , smart people discovered heparin , extracted it first from the swine and later made synthetics. It does not stop clotting that is going on at the moment but stops new cascades in I think X and XI steps ( do not cite me one of those steps 1 - 12 for sure) So , it has very short half life but it works until starts to feel too powerful and decide to wreak a havoc and induce thrombocytopenia which is famous HIT disease BAD, BAD, BAD disease... bleeding going on all around the place. So , people decided to make Low molecular weight heparin or otherwise called Lovenox which is still heparin and is still able to produce HIT but not so often. It is given 1 mg/ kg usually q 12 hours ( that is his half life) , or sometimes 40 mg q day depending on situation and genetics. It is good for pregnant and breastfeeding does not cross placenta. The draw back is MONEY . Expensive and insurance will not cover it easy.. .So then comes in Coumadin most save but still bleeding issues , problems with diet , cheking INR from time to time, and all that. It needs bridge therapy because it does not get right away on track so usually Lovenox is given for 5 - 10 days together with coumadin and then coumadin is left to do the job. It is tricky med. Has very narrow therapeutic level. If it goes lower then needed then it does not work, if it goes more then needed then it works too much ) and pt end up bleeding so it is very fine constant care and education included.
    I hope this helps a little bit.
    Shan-Shan and mamamerlee like this.
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    it does thanks, very interestiing............
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    Also add in there Fragmin- this is being used in my hospital in place of Lovenox. Has something to do with purchasing I'm sure- but I think it's something to be aware of. We routinely give Fragmin now- partly because it is a once a day dosing instead of the lovenox which is sometimes given BID.


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