Some questions about heparin/coumadin, help!

[CrystalClear75]

Hi there,

Here's a few questions for ya, if you could help me that would be great!

1. What lab value is monitored to dtermine the correct blood level for heparin? For coumadin? What is considered therapeutic?

I THINK: INR for coumadin 1.3-2 and PT-11.6-9.8seconds

HEPARIN: APTT 20-30 seconds to maintain

APTT: 1.5-2.5 x normal therapeutic

2. If someone on either of these requires surgery or begins to bleed, how would the effects be reversed?

I THINK: Antitdote for heparin is propamine sulfate which helps stop the bleeding.

3. What is the stated advantage of the new low-molecular weight heparins ovet the older cheaper version? NOT SURE

4. Heparin is given prophylactically to the post-postoperative patient. What does that mean? why is it given to this group of patients?

I THINK: It is also used prophylctilcally in patients with short term increased risk of thrombus formation, such as in the postoperative period after a total hip replacement.

5.Heparin is given therapeuticallly to someone who has developed DVT or to someone who is suspected of having a pulmonary embolus. What is the difference between the prophylactic and therapeutic dosages and method of administration?NOT SURE

6. What is the most common medication error related to administering heparin? NOT sure yet

I answered some of these but I want to see what you came up with. These are just extra study questions that would be nice to know. I know it's alot but I'm not 100% sure i'm right and i just want to see what you come up with. Thank you SO much!

[BabyLady, BSN, RN]

Also regarding why LMWH is beneficial--in situations where LMWH or Heparin is being used for post-op prophylaxis, I'd say fewer needle sticks are a benefit. When I receive post op pts to rehab on heparin, they are typically on 5,000 units SC q8h. When I receive people on Lovenox, they are typically on 30mg or 40mg SC q24h.

I think (and please correct me if I am wrong or if I am confusing it with something else)....the reason that low-molecular weight heparins have over cheaper versions, is I think the older-versions have to be subject to more frequent, therefore, more expensive testing.

Heparin has a short-duration of action in the body....oral anticoagulants are more for long-term anticoagulant therapy.

It is also extremely important to assess the patient's eating habits to see how much Vitamin K foods that they consume, as these interfere with the action of anticoagulants.

It's not that you cannot consume the foods at all..it's that if you consume them at higher levels, and your physician keeps "upping" the dosage of the anticoagulants, and then you decide to take a break from Vitamin K foods, this can significantly increase the action of the anticoagulants and possibly cause spontaneous bleeding. The key is consistency.

[fanshawe]

i think a previous poster touched on this, but i'm not sure if it was said outright. LMWHs have a lower incidence of causing HIT than unfractionated heparin. LMWH is also given in standardized doses (1mg/kg, i think) and has a more predictable effect. fewer coag studies are necessary because the clotting factor that LMWH acts upon isn't measured by PT, aPTT or INR. i'm suspicious of the claim that you can eliminate coag studies with LMWH, but the literature out there seems to agree with that. anyone have any insight into that particular issue?

[NurseKitten, MSN, RN]

Is anyone seeing much Argatraban used for people who are either allergic or have HIT?