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Chapter 27
Drugs Used to Treat
Thromboembolic Disorders
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 27
Lesson 27.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
• Describe conditions that place an individual at
risk for developing blood clots
• Analyze Figure 27-1 to identify the site of
action of warfarin, heparin, and fibrinolytic
agents
• State the primary purposes of anticoagulant
therapy
• Identify the effects of anticoagulant therapy
on existing blood clots
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Objectives (cont’d)
• Explain laboratory data used to establish
dosing of anticoagulant medications
• Describe procedures used to ensure that the
correct dose of an anticoagulant is prepared
and administered
• Identify specific nursing interventions that can
prevent clot formation
• Develop objectives for patient education for
patients receiving anticoagulant therapy
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Thromboembolic Diseases
• Include the process of forming a blood clot or
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•
•
•
thrombus
Fragments of a thrombus can break off and
circulate until trapped in a capillary, creating
an embolus
Clotting cascade is activated when a blood
vessel is injured, or with increased viscosity
Intrinsic clotting pathway
Extrinsic clotting pathway
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Nonpharmacologic Treatment
of Thromboembolic Diseases
• Prevention of conditions that cause clots to form
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Immobilization with venous stasis
Surgery, trauma to lower limbs
Heart failure, vasospasm
Cancers of the lung, prostate, stomach, pancreas
Pregnancy, oral contraceptives
• Ways to prevent stasis: leg exercises, wearing
stockings, leg elevation, sequential compression
devices
• Revascularization treatments: percutaneous
coronary intervention, coronary artery bypass
graft
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Drug Therapy Goals
for Thromboembolic Diseases
• Primary purpose is to prevent platelet
aggregation or inhibit steps in the clotting
cascade
• Four types of agents
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Platelet inhibitors
Anticoagulants
Glycoprotein IIb/IIIa inhibitors
Thrombolytics
• Anticoagulation therapy prevents new clot
formation or extension of existing clots
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Laboratory Tests
for Thromboembolic Diseases
• Coagulation tests
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PT (prothrombin time)
aPTT (activated partial thromboplastin time)
INR (international normalized ratio)
Platelet counts
• Diagnostic tests
 PT, aPTT, hematocrit, platelet count, Doppler
studies, exercise testing, serum triglycerides,
arteriogram, cardiac enzyme studies
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Slide 8
Correct Dosing
• Key in the treatment of conditions used to
control clots
• Use medication administration record for
scheduling
• Mark one-time dosages clearly
• Never administer anticoagulants before first
checking the chart for most recent laboratory
results
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Patient Education
for Anticoagulation Therapy
• Diet and nutrition
 Limit intake of leafy green vegetables
 Drink six to eight 8-ounce glasses of fluid daily
• Exercise and activity after surgery to prevent
venous stasis
• Do not flex knees or place pressure under
knees; avoid being motionless
• Medication regimen
 Dose and timing, common and serious
adverse effects, drug interactions
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
The Clotting Cascade
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Slide 11
Chapter 27
Lesson 27.2
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Slide 12
Objectives
• State the nursing assessments needed to
monitor therapeutic response and
development of common and serious adverse
effects from anticoagulant therapy
• Explain the specific procedures and
techniques used to administer heparin
subcutaneously, via intermittent
administration through a heparin lock, and via
IV infusion
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Objectives (cont’d)
• Identify the purpose, dosing determination,
and scheduling factors associated with the
use of protamine sulfate
• Describe specific monitoring procedures to
detect hemorrhage in the patient taking
anticoagulants
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Slide 14
Drug Class: Platelet
Inhibitors
• Actions
 Inhibit platelet aggregation
• Uses
 Primary prevention of MIs and stroke; prevent
blood clots from forming
• Common adverse effects
 Abdominal distress, hypotension
• Serious adverse effects
 Neutropenia, agranulocytosis, bleeding
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Drug Class:
Anticoagulants
• Actions
 Low molecular weight heparin (LMWH)
• Uses
 Prevent deep vein thrombosis after hip
replacements or abdominal surgery; prevent
MIs, combined with aspirin
• Common adverse effects
 Hematoma formation, bleeding at injection site
• Serious adverse effects
 Bleeding, thrombocytopenia
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Drug Class: Anticoagulants
• Drug: heparin
• Actions
 In the presence of heparin, antithrombin III
neutralizes thrombin, factors IXa, Xa, XI, and
XII, as well as plasmin
• Uses
 Treat deep vein thrombosis, pulmonary
embolism, cerebral embolism
• Can be given subcutaneously, IV push, IV
infusion
• Dosages vary depending on route
• Monitor aPPT, platelets, hematocrit
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Assessment for Bleeding
• Monitor to detect hemorrhage
• Symptoms of internal bleeding
 Decreased blood pressure, increased pulse,
cold clammy skin, faintness, disorientation
• Consider all areas of the body that could
begin to bleed (visible and internal)
• Monitor laboratory values
 aPPT, platelets, hematocrit
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Drug Class:
Glycoprotein IIb/IIIa Inhibitors
• Drugs: abciximab (ReoPro), eptifibatide
(Integrilin), tirofiban (Aggrastat)
• Actions
 Block receptors on platelets, preventing
aggregation and clot formation
• Uses
 Prevent clots forming from the debris often
released during percutaneous coronary
intervention (PCI) procedures
• Serious adverse effects
 Bleeding, thrombocytopenia
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Drug Class: Fibrinolytic Agents
• Drugs: streptokinase, alteplase (Activase),
reteplase (Retavase), tenecteplase
(TNKase)
• Actions
 Stimulate the bodies own clot-dissolving
mechanism, converting plasminogen to
plasmin, which digests fibrin
• Uses
 Dissolve fibrin clots secondary to coronary
artery occlusion (MI), pulmonary emboli,
cerebral emboli, deep venous thrombosis
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20