Heparin vs Coumadin

[TemperStripe]

I had a pre-op Pt who's INR had been continually high. Hx of DVT's, so he was on coumadin at home. INR was down to 3.1 (from 4.5, I think.) They wanted to take him to surgery the next day...so they gave him a unit of FFP to bring down the INR even more, but also put him on a heparin gtt. This all happened at the end of my shift so I got home and realized I was a little confused about this...please correct and inform me.

PTT and INR represent different areas of the clotting cascade so I'm assuming they want to bring down his INR so he doesn't bleed and put him on the heparin gtt, which is shorter acting than coumadin, to make sure he didn't throw a clot? Walking the fine line of anticoagulation...?

Thanks for your input!

[detroitdano]

You've pretty much figured it out. Heparin is near impossible to use as a home medication so they usually give everyone Coumadin, maybe a few weeks of Lovenox if they have a DVT.

Heparin is easier to titrate in the hospital than Coumadin, and as you mentioned, has an extremely shorter half life.

PTT high? Shut it off, drop it a few hundred units/hr, recheck, and tada you're done and you've got your anticoagulation.

INR high? Throw some vitamin K or FFP's at the guy, recheck INR, and when it's within whatever range makes the OR team happy you're good to go.

[CrufflerJJ, BSN, RN, EMT-P]

Depending on the type of OR (especially cardiac), the surgical team may also tweak the clotting time in the OR with either heparin or protamine sulfate.