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?

[group_theory]

The reason why you start on both lovenox and coumadin is because starting coumadin will make the blood initially hypercoagulable ... and thus you need either lovenox or heparin to prevent further clot formation.

Coumadin works by inhibiting Vitamin-K dependant factors, such as II, VII, IX, and X, along with Protein C and Protein S. Protein C and Protein S responds a lot more quickly to decreased Vitamin K caused coumadin compare to other Vitamin-K dependant factors. As a result, the patient is in a hypercoaguable state. It is only when factors II, VII, IX, and X are decreased is when the patient goes from the hypercoaguable state to an anticoaguable state (and hence why it takes several days for the INR to be elevated)

Lovenox is given in the meanwhile to keep the patient in an anticoaguable state until coumadin kicks in. Lovenox (and heparin) works by a completely different mechanism (mainly by activating antithrombin III) and thus have an immediate effect by inhibiting thrombin and Factor Xa.

Neither coumadin or lovenox is intended to remove the clot either in a DVT or a PE ... it is to prevent further clot formation. The body will take care of the clot by slowing removing it using its own thrombolytics, but it usually take a while ... that's why people with DVT or PE will have to be on coumadin for months on end

[Roy Fokker, BSN, RN]

heparin is the buster

coumadin is the preventor

heparin doesn't "bust" clots. along with coumadin, heparin "prevents" clots.

see:

no, lovenox does not "attack" the existing clot. heparins (i'm including lovenox) and coumadin both work by preventing the formation of blood clots/keeping the clot from growing. however, they work by inhibiting different clotting factors and have very different kinetics.

the only drugs that break down clots are thrombolytics -- such as tpa.

and:

neither coumadin or lovenox is intended to remove the clot either in a dvt or a pe ... it is to prevent further clot formation.

cheers,

:)