Question

T.M., a 57-year-old man, has thrombophlebitis in the right lower leg. IV heparin, 5000 units by bolus, was given. Following the IV bolus, heparin 5000 units given subQ q6h was prescribed. Other therapeutic means to decrease pain and alleviate swelling and redness were also prescribed.

1. How does heparin work and why was it prescribed?
2. What laboratory test(s) would be monitored for patients taking heparin? Explain your answer.
3. Explain the differences between heparin and enoxaparin. Are there advantages to either of these anticoagulants?

After 5 days of heparin therapy, T.M. was prescribed warfarin 5 mg PO daily.

4. Why was T.M changed to warfarin? What is the pharmacologic action of warfarin?
5. What laboratory test(s) would be monitored for patients taking warfarin? Explain your answer.
6. Explain the half-life and protein-binding for warfarin. What additional concerns do you have? How does this knowledge impact teaching for patient’s taking warfarin? Explain.
7. What assessments should be performed before starting anticoagulant therapy?
8. Explain the nursing considerations and patient teaching for anticoagulant (include rationale).

Answer 1

Ans)MOA of heparin- Inhibits clotting factors IIa (thrombin) and Xa

Heparin activates the fibrinolytic system to break down the clot (thrombus).

Heparin is prescribed to prevent patients from having a stroke who are at risk, and also for pts that clotting disorders and for the prevention of Stroke, Myocardial infarction (MI), Deep vein thrombosis (DVT) and Pulmonary embolism (PE).

- During heparin- therapy ,aPTT lab value should be monitored as aPTT is considered a more sensitive version of the PTT and is used to monitor the patient's response to heparin therapy. The reference rangeof the aPTT is 30-40 seconds. The reference range of the PTT is 60-70 seconds.

Difference between Heparin and enoxaparin( LMWH)- Low Molecular Weight Heparin:

- Heparin therapy is usually restricted to the hospital setting, where its effect can be monitored and its dosage adjusted frequently. In contrast, LMWH preparations can be administered in either the in-hospital or out-of-hospital setting because they can be administered subcutaneously (sc) without the need for laboratory monitoring.