Perfusion and Renal Elimination
6.12 Blood Coagulation Modifiers
Blood Coagulation Modifiers
This section discusses medications that affect blood coagulation, and includes several types of medications, including anticoagulants, anti-platelets, and thrombolytics, as well as their associated reversal agents.
Anticoagulants prevent the formation of a clot by inhibiting certain types of clotting factors. Anticoagulants include the following drug classes: heparins or unfractionated heparin and low molecular weight heparin (LMWH), warfarin (Coumadin), selective factor Xa inhibitors (Rivaroxaban), and direct thrombin inhibitors (dabigatran). Anti-platelets include Aspirin and other aggregation inhibitors such as Clopidogrel, and thrombolytics include Alteplase (tPA). These medications create a high risk of bleeding.
The most common anticoagulant errors in acute hospital settings are administration mistakes, including incorrect dosage calculation and infusion rates. The Health Research and Educational Trust focuses on reducing harm related to HAMs by 50% and recommends the following interventions to achieve this goal:
- Educate staff based on evidence and best practices.
- Use standardized order sets and protocols.
- Perform medication reconciliation at all transitions.
Specific interventions regarding anticoagulant therapy include standardization of protocols for withholding and restarting warfarin perioperatively, as well as pharmacists on rounds to provide decision support for staff administering HAMs and to reduce prescribing errors, pharmacist monitoring of anticoagulants, and pharmacist notification when rescue medications are given.[1]
Since 1954, warfarin has been a standard but hazardous treatment for preventing blood clots. Warfarin requires close laboratory monitoring and individual dose adjustments based on PT and INR lab results. When the pharmaceutical industry began marketing modern replacements for warfarin, including dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis), they designed them to be easier to use than warfarin because no laboratory monitoring was required, but not necessarily safer. It is vital for nurses to provide thorough client and caregiver education for clients prescribed anticoagulants at home. Suggested client education topics are included for each type of medication below.
Heparin Sodium
Heparin sodium is an anticoagulant that can be injected or used intravenously and is formulated in several dosages. (See Figure 6.12.)[2] Because heparin is a high-alert medication, hospitals use several processes for storing and labeling it to help prevent errors. As nurses, we must ensure safety by following the appropriate steps when choosing which vial to draw up medication from, and follow hospital protocols during administration. Heparin is given by injection or intravenously. Most hospitals have weight-based protocols for IV heparin administration that titrate a client’s dosage to be within a therapeutic range b