lovenox..and coumadin

[LisaRn21]

My mother had a huge PE .. they are sending her home on both lovenox and coumadin...I don't understand why both.. when my mother asked they said that her daughter (me ) could explain it better but I work with kids and ever hardly ever I can only think of one patient I gave anticoagulants to so I am not sure... anyone have experience with this?

[matt59]

Is it possible that they each work on a different clotting factor?

that is just a guess....

[KellNY, RN]

I've seen this in practice (never given it though).

NOW-I would call the RNs on that unit, because "You can ask your daughter" is completely unacceptable. Completely. Not giving adequate patient education is not an option when discharging a pt after a PE.

[mced]

Rat poison (coumadin) takes longer to reach a therapeutic level than lovenox. Once her INR is around 2-3 they will probably d/c the lovenox. In the meantime the lovenox helps to prevent any further clot development.

[majorwrigley]

Lovenox is a form of heparin. your dad will likely be taken off lovenox after his pt levels are acceptable with the coumadin.

[CritterLover, BSN, RN]

usually, the heparin (lovenox) is given until the coumadin is threapeutic (inr level).

while this usually happens in the hospital, by using lovenox instead of iv heparin, it can be done at home since lovenox has predictible dosing in most (non-obese) patients. heparin does not have predictible dosing, and so labs need to be monitored frequently.

however, agree that it should have been explained better to your mother.

[dream'n, BSN, RN]

I have had patients on Heparin and Coumadin. I finally got a Dr. to sit down and explain it all to me. Very interesting, it seems that they do work on different clotting factors and do not thin the blood in the same way, hence one is followed with an INR and one is followed with a PTT. Unfortunately some of what he explained was very complicated and 'over my head,' but I did get the basics.

[Tweety, BSN, RN]

Rat poison (coumadin) takes longer to reach a therapeutic level than lovenox. Once her INR is around 2-3 they will probably d/c the lovenox. In the meantime the lovenox helps to prevent any further clot development.

This is when I have seen both given as well. Coumadin takes a while to become therapeautic. There are sometimes meds that interfere and take it longer to become therapeutic.

While the Coumadin is becoming therapeautic the Lovenox is given to prevent clot formation. When the Coumadin is able to handle this alone, the Lovenox should be discontinued.

[NRSKarenRN, BSN, RN]

Re: Can someone please explain INR & Coumadin therapy to me?

[TazziRN, RN]

"Your daughter can explain it"?????? What a totally unacceptable answer!!!

[LisaRn21]

Thanks guys! I get it now that would make total sense......and yes it is unacceptable so is a ton of stuff that has happened in the past 2 weeks....ie the room not being cleaned before she was placed there....insulin being given without checking the bs (the cna charted it so its done says the nurse...yet I didn't leave the bed side and she didn't do it while I was there), telling my mom she stunk cause she hadn't bathed in a week (well duh! she was sedated and intubated in the ICU ... geez) oh and the list goes on ... never ever would have thought this from a top ten hospital, needless to say the nurse manager and I had a little chat ... but thanks for the info guys!!

[CarVsTree]

I have had patients on Heparin and Coumadin. I finally got a Dr. to sit down and explain it all to me. Very interesting, it seems that they do work on different clotting factors and do not thin the blood in the same way, hence one is followed with an INR and one is followed with a PTT. Unfortunately some of what he explained was very complicated and 'over my head,' but I did get the basics.

As far as I know, Lovenox (non-fractionated heparin, is NOT monitored via PTT).