confused about heparin, lovenox, coumadin etc.

  1. We are learning about dvt's etc and I am very confused about the anticoag's meds, they seemed to be used interchangeablly is their a specific protocol when you would want to use a heparin drip as opposed to lovenox and when does coumadin come into play? Im just confused as the diffrences between the three drugs any help would be great - Thanks
  2. Visit Jnsaxton profile page

    About Jnsaxton

    Joined: Mar '09; Posts: 5


  3. by   Lorie P.
    Lovenox is usually given to just about every pt in the hospital now days, especially if the are bed confined, it helps to prevent clots since the pt isn't up or moving around.

    Coumadin is usually give for "A Fib" pts and pts with a dx of DVT's PE's or other clots.

    Heprin- depends on the doc and where the clot is, mostly it is a drip but you can give SQ.

    Break out your pharmacology book and read , read, read.
  4. by   nminodob
    My admittedly limited knowledge: A hep drip would be seen in the hospital setting with a pt. who has a dvt for example, although many other dx may also require a hep drip. The dr would probably order coags (blood tests) q 4-6 hours to make sure the clotting time is within the target range, which would be a pre-determined parameter (the test is ptt for heparin therapy). The lovenox sq injection I have usually seen prophylactically - meaning for those immobile pts who are at risk for clots. Coumadin (warfarin) is another anti-coagulant that a pt with various dx, such as a-fib for example, may be prescribed. Coumadin is an oral med and also requires blood tests (pt/INR), usually every couple of weeks to keep the pt in the target range. Sometimes a pt will receive IV heparin in the hospital setting, but will be fairly quickly switched over to Coumadin po so they can go home with the med. Depending upon dx, the pt may stay on oral anti coags (Coumadin) indefinitely, getting the periodic blood tests to keep the clotting time within the parameters that the dr has determined is best. Hope this helps - I am sure many other nurses have more info to add!
  5. by   Daytonite
    looking up these medications in a drug reference would be a great help, especially if you look at the nursing considerations because they will discuss specific protocols and lab tests required to monitor the effects of these drugs.

    heparin is an anticoagulant that is given iv or subcutaneously, has an onset of action in 20-60 minutes and duration of 8 to 12 hours. this is the drug that dennis quaid's twins were overdosed with. the drug is stopped immediately and protamine is given for overdose. here is an online monograph about this drug:

    lovenox (enoxaparin sodium) is also a anticoagulant and chemically a low-molecular-weight heparin that can only be given subcutaneously and has a peak activity in 3 to 5 hours before it is rapidly eliminated through the renal system. in order for a steady state of anticoagulation to be reached this drug must be given at a specific times each day. protamine equal to the dose is given for overdose. here is an online monograph about this drug and how to administer it:

    coumadin (warfarin) is another anticoagulant that is primarily given orally although there is an iv form of it. onset is 12 to 24 hours, peak action is one and a half to 4 days and duration of action is 3 to 5 days. vitamin k is given for overdose. here is an online monograph about this drug:

    heparin is the drug used in the acute hospital setting to begin immediate anticoagulation because its onset of action is immediate (within 20 minutes). ptt levels will be monitored every 6 hours to titrate the dose of heparin. coumadin is started within a day or two. coumadin needs several days for its effects to build within the persons system, so the patient may have their heparin drip going while they are getting a daily dose of the coumadin. daily pt levels will be drawn to monitor the anticoagulation effect of the coumadin. as soon as pt levels start to elevate, an indication that the dose of coumadin is effective, the heparin will be discontinued.

    lovenox is given as a prophylactic measure--to prevent the formation of a blood clot. it is commonly prescribed for postop patients as a preventative from them getting a dvt while immobile. if a patient already has a dvt it is unlikely that lovenox would be one of the drugs used to treat it. after the clot is resolved, this drug may be used later as a preventative so clots do not form again. a therapeutic dose of coumadin may also be given for that same reason.
    Last edit by Daytonite on Apr 5, '09
  6. by   nminodob
    Your post has a lot of useful info - however, if I am not mistaken, the PT test is used with Coumadin, and PTT with heparin, not the other way around.
  7. by   Daytonite
    Quote from nminodob
    Your post has a lot of useful info - however, if I am not mistaken, the PT test is used with Coumadin, and PTT with heparin, not the other way around.
    You're right! What was I thinking? I edited my post. Thank you.
  8. by   Jnsaxton
    Thank you so much for all the info - I knew what the drugs did but my book didnt say what different situations called for different drugs (med surg) of course I didnt consider my drug book, which is probably the first place I could have gone, but you ladies (or guys) did a great job w/ your explanations - Thanks so much
  9. by   hypocaffeinemia
    I recommend pulling out your A&P book and re-reading the chapter on coagulation dealing with the intrinsic and extrinsic pathways in order to gain a deeper understanding of how each of the various anticoagulants affects your patients.
  10. by   Jnsaxton
    Honestly I have no idea what you are talking about so I am taking out the A&P book and looking it up now - Thanks