anticlotting medications

[jmaverick101]

I work on a telemetry floor. A majority of patients i have are either on coumadin or plavix when they come in. If their INR isn't therapuetic they get on lovenox/heparin. My question is regarding whether a patient needs to have lovenox if their on plavix. And if so the rationale.

[Emergency RN]

The best way that I had this describe to me was using the "bricks and mortar" analogy, where the Fibrin is the mortar, and the platelets are the bricks. HEPARIN, LOVENOX, and COUMADIN all affect the mortar, while PLAVIX and ASPIRIN affect the bricks. HEPARIN, LOVENOX, and COUMADIN would prevent the formation of Fibrin (the classic material of the clot found in between the platelets), while the PLAVIX or ASPIRIN prevents platelets from sticking or clumping together in the first place.

HEPARIN, or LOVENOX (a low molecular weight long acting HEPARIN) inhibits the conversion of Prothrombin to Thrombin (which converts fibrinogen to fibrin), is used to keep clotting times slightly elevated until COUMADIN starts to have an effect, generally 2 - 3 days later. PLAVIX (like ASPIRIN) prevents platelet aggregation, so on the typical telemetry unit, it would be entirely possible to have a patient on both LOVENOX and PLAVIX for the first few days, then with an anticipated switch to COUMADIN and PLAVIX (or ASPIRIN) later on.

All of this of course, relies on in depth knowledge of the patient and individual medical judgment.

[tewdles, RN]

http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm190787.htm

FDA states patients shouldn't be on Plavix and Prilosec together...just a semi-related FYI.