PTT vs PT/INR

Published

Please can anybody help? I am quite confused.

Textbooks all over the place tell you that when the patient is on heparin s/he needs to check PTT regularly, and when on warfarin sodium s/he needs to check PT/INR regularly.

I just found a question that reads like this:

The nurse is discharging a client diagnosed with deep vein thrombosis (DVT). Which discharge instructions should be provided to the client?

1) Have the PTT levels checked routinely to maintain a therapeutic level.

2) When traveling, the client should plan rest stops to exercise the legs.

3) Eat a diet high in green leaf vegetables and expect the urine to be red-tinted.

4) Wear knee stockings with an elastic band around the top.

I selected no.1 but the correct answer is showing to be no.2

This is the rationale:

Correct answer 2: The client should perform frequent active and passive leg exercises. In an airplane the client should be instructed to drink plenty of fluids and move the legs up and down and flex the muscles. In an automobile the client should take frequent breaks to walk around. PT/INR should be monitored.

Now I understand the reason why instructions on leg exercises are given but I don't understand why PT/INR is to be checked instead of PTT given DVT patients are normally on heparin.

Thank you for your help.

Up Vote Up Vote ×

The patient is being discharge home so he/she is going to continue with Coumadin instead of heparin.. They monitor PT and INR for Coumadin..

Up Vote Up Vote ×

Heparin SubQ may be done home. Also anticoagulation therapy for the first episode of DVT should last 3-6 months with LMWH (low molecular weight heparin).

Up Vote Up Vote ×
Please can anybody help? I am quite confused.

Textbooks all over the place tell you that when the patient is on heparin s/he needs to check PTT regularly, and when on warfarin sodium s/he needs to check PT/INR regularly.

I just found a question that reads like this:

The nurse is discharging a client diagnosed with deep vein thrombosis (DVT). Which discharge instructions should be provided to the client?

1) Have the PTT levels checked routinely to maintain a therapeutic level.

2) When traveling, the client should plan rest stops to exercise the legs.

3) Eat a diet high in green leaf vegetables and expect the urine to be red-tinted.

4) Wear knee stockings with an elastic band around the top.

I selected no.1 but the correct answer is showing to be no.2

This is the rationale:

Correct answer 2: The client should perform frequent active and passive leg exercises. In an airplane the client should be instructed to drink plenty of fluids and move the legs up and down and flex the muscles. In an automobile the client should take frequent breaks to walk around. PT/INR should be monitored.

Now I understand the reason why instructions on leg exercises are given but I don't understand why PT/INR is to be checked instead of PTT given DVT patients are normally on heparin.

Thank you for your help.

The patient will not be going home on heparin. They will be discharged with coumadin and/or Lovenox. If they are discharged on Coumadin, The test they would need is pt/inr therefore the only correct answer is 2.

Up Vote Up Vote ×
Heparin SubQ may be done home. Also anticoagulation therapy for the first episode of DVT should last 3-6 months with LMWH (low molecular weight heparin).

I have never seen a patient discharged home with heparin as it would need to be given 3-4 times per day. LMWH is not the same as heparin. A brand name would be Lovenox. You do not monitor PTT with Lovenox/LMWH.

Up Vote Up Vote ×

whoops sorry..you do not monitor aPTT with LMW heparins or with Fondaparinux BUT you may prescribe LMW heparin or Fondaparinux for home use DEFINITELY. So the reason why the answer is incorrect is that you do not monitor anything not just aPTT. They need to modify the rationale.

Up Vote Up Vote ×

At our hospital where i work, patient is on heparin and when there is an order for discharge, they would start weaning off heparin and start coumadin to home.

Up Vote Up Vote ×
whoops sorry..you do not monitor aPTT with LMW heparins or with Fondaparinux BUT you may prescribe LMW heparin or Fondaparinux for home use DEFINITELY. So the reason why the answer is incorrect is that you do not monitor anything not just aPTT. They need to modify the rationale.

I assume the rational speaks of PT/INR because as I said before many patients only use Lovenox as a bridge to therapeutic Coumadin levels at home. So PT/INR levels would be checked for the Coumadin. It would not be reasonable for a patient to need to inject themselves daily at home with Lovenox for 3-6 months. Most insurances would not cover that since Lovenox os so expensive.

The question and rationale make complete sense to me.

Up Vote Up Vote ×
Specializes in ICU, ED.

Are you studying for NCLEX? If so, be careful - you ASSUMED the patient was taking heparin because of his diagnosis. You actually could have eliminated answer 1 from the get-go because the question never mentioned a drug. Make sure you understand what the question is asking before you answer the question.

Up Vote Up Vote ×

For example. Here is a common protocol for sending patients with lower extremity DVT's home from the ED:

Enoxaparin (Lovenox) 1 mg/kg subcutaneously twice daily for at least 5 days and warfarin (Coumadin) maintenance therapy to reach an INR 2.0 - 3.0; discontinue enoxaparin when INR is > 2.0 for two consecutive days.

Up Vote Up Vote ×
Are you studying for NCLEX? If so, be careful - you ASSUMED the patient was taking heparin because of his diagnosis. You actually could have eliminated answer 1 from the get-go because the question never mentioned a drug. Make sure you understand what the question is asking before you answer the question.

You're right. Thank you very much!

Up Vote Up Vote ×
Specializes in NICU.
Are you studying for NCLEX? If so, be careful - you ASSUMED the patient was taking heparin because of his diagnosis. You actually could have eliminated answer 1 from the get-go because the question never mentioned a drug. Make sure you understand what the question is asking before you answer the question.

That is a very important point with NCLEX questions. PTT is done for Heparin. The question did not state that the patient was on Heparin, so eliminate that answer. The biggest problem for new grads with health care experience is to use your own experience as to how to answer the question. NCLEX lives in a "perfect" world. If the info is not in the stem of the question, it doesn't exist.

Up Vote Up Vote ×
+ Join the Discussion