TIP FOR THE DAY - Anticoagulants

[ellord]

Hi, all. Tip for the day.

Anticoagulants

heparin---given IV-----prevents clot formation----Protamine Sulphate works againt hep

Coumadin---Taken per Os------slows clot formation---Vit K works against Coumadin

Normal aPPT: 20--36sec

when one is on Hep infusion, aPPT increases by 1.5---2.5x normal

Normal clotting time (PT): 9.5/9.6----11.3/11.8sec

INR: 2--3( for standard Coumadin therapy) 3--4.5( for high dose therapy).

Because coumadin slows clot formation, clotting time is prolonged by 1.5---2x normal

So usually a client will be started on Hep and weaned off with Coumadin.

In prioritizing care, a patient who is due for Coumadin is not a priority cos Coumadin action lasts for about 2-5 days.

[Sturmgeist]

Thank you. That priority rule will help!

[my_purpose]

Awesome information for review - do you post these each day?

[ellord]

@my_purpose

i started today. i noticed most people have issues with Pharm, so i decided to step in to make it easy for all. pharm is lovely...........

[studentdrtobe]

Just wanted to add some clarifications:

Heparin -- IV, quick action, works by activating antithrombin III and can be rapidly reversed with protamine

Warfarin -- oral, delayed action, works by inhibiting vit K-dependent clotting factors (hence why vit K therapy inhibits warfarin's anticoagulant action)

Both function to prevent clot formation.

The activated partial thromboplastin time, aPTT (not aPPT), is used to monitor heparin therapy. aPTT is also used to assess the intrinsic and common coagulation pathways (remember, there are several pathways through which the clotting cascade can be activated). The prothrombin time (PT) measures the extrinsic and common coagulation pathways and is used to measure warfarin therapy. Like you mentioned, we normally aim for an INR value between 2 and 3 with warfarin therapy (unless patient has other issues, like a mechanical heart valve, etc, in which case, we want the INR to be higher).

Not entirely sure what you mean by "client will be started on Hep and weaned off with Coumadin." Heparin is commonly used to "bridge" to warfarin therapy. Since warfarin exhibits a delayed action and, more importantly, because warfarin induces a temporary hypercoagulable state initially (by depleting protein C and protein S, which are anticoagulants), you start off with heparin + warfarin until the INR confirms that you've reached a therapeutic warfarin dose (ex. INR of 2-3, like you mentioned).

[ladyt08]

Thanks......very good information from the both of you....i look forward to seeing more post :)

[ellord]

great info studentdrtobe.