2. Overview
Pharmaceutical agents that modify coagulation are used to
prevent clot formation or break apart an already formed clot
The goal of medication that alter coagulation is to increase
circulation and perfusion, decrease pain and prevent further
tissue damage
A clot that adheres to a vessel wall is called thrombus while an
intravascular clot that floats in the blood is called embolus
The group of medications used include oral and parenteral
anticoagulants, antiplatelet, and thrombolytic agents.
3. Anti coagulant
Inhibit either the action of coagulation factors or
interfere with the synthesis of coagulation factors
4. Anti platelet
Decrease the formation or action of chemical signal
that promote platelet aggregation
Inhibit cyclooxynase-1 enzyme (COX-1) or block
GP11b/111a or ADP receptors
5. Thrombolytic Agents
Activate the conversion of plasminogen to plasmin, a
serine protease that hydrolyzes fibrin and thus,
dissolves clot
6. ANTI COAGULANTS
1) ENOXOPARIN SODIUM (Clexane)
Therapeutic category: Anticoagulant
Mode of action
Prevent thrombus formation or extension of an
existing thrombus in the slower moving venous
Indications
Prevention of venous thrombosis
Treatment of DVT
Pulmonary embolism
7. Enoxaparin contd
Prevention of clotting in extra coporeal circuit
Dosage
20mg for DVT
1.5mg/kg for pulmonary embolism
Route of administration: Sc
Side effects
Haemorrhage, thrombocytopenia
Hypersensitivity reaction (urticaria)
8. Enoxoparin contd
Contra indications
Haemophilia, haemorrhagic disorders, peptic ulcer
Severe liver disease, cerebral haemorrhage,
threatened abortion, severe hypertension
Following surgery of the eye, brain or spinal cord
Nursing responsibilities
Estimate blood clotting time
Monitor platelet count (discontinue for platelet count
less than 100,000/mm3)
10. 2) HEPARIN(Lipo-Hepin)
Therapeutic category: Anticoagulant
Mode of action
Bind to antithrombin 111, with subsequent rapid
inactivation of coagulation factors
Prevent conversion of fibrinogen to fibrin in a blood
clotting mechanisms
12. Heparin contd
Route of administration: IV, Sc, IM
Side effects
Haematuria, malaena, epistaxis, fever, headache
Nausea, vomiting, constipation
Contra indications
Haemorrhagic conditions, haemophilia, peptic ulcer
Cerebrovascular disorder, severe hypertension, severe
anaemia
13. Heparin contd
Nursing responsibilities
Estimate blood clotting time
Discontinue treatment if thrombocytopenia occur
In case of over dose, give IV antidote (protamine
sulphate 50mg)
Other anticoagulants includes Tinzaparin, Daltaparin
and Warfarin sodium
14. ANTI PLATELET
1) CLOPIDOGREL (Plavix)
Therapeutic category: Antiplatelet
Mode of action
Inhibit the binding of ADP to its receptors on platelet
Inactivation of GP11b/111a receptor
Decrease platelet aggregation and inhibit thrombus
formation
16. Plavix contd
Side effects
Bleeding disorders, gastric and duodenal ulcers,
dizziness
Eosinoplillia, headache, paraesthesia.
Contra indications
Active bleeding, breastfeeding
Nursing responsibilities
Monitor blood clotting and bleeding time
17. Plavix contd
Laboratory investigation for blood cell count to rule
out blood disorders (i.e. leucopenia,
thrombocytopenia)
18. 2) ASPIRIN(Ecotrin coated)
Therapeutic category: Anti-platelet
Mode of action
Inhibit thromboxane A2 synthesis from arachidonic
acid in platelet by irreversible acetylation of serine
Also has (anti-inflammatrory, pyretic, rheumatic) and
analgesic therapeutic effect
20. Aspirin contd
Route of administration: Oral
Side effects
GI upset, bronchospasm, allergic reaction, and other
haemorrhage
Black tarry stool, coffee ground emesis, tinnitus
Contra indications
Previous or active peptic ulcer, haemophilia
Bleeding disorders, severe renal or hepatic
impairment
21. Aspirin contd
Nursing Responsibilities.
Monitor for aspirin toxicity (hearing loss, tinnitus)
Monitor for gastric bleeding (coffee grounded emesis and
black tarry stool)
Advise client to use enteric coated tablet and to take with
food
If symptoms persist, withhold dose and notify healthcare
provider
Other anti platelet includes Ticlopidine, Cilostazol,
Abciximab and Prasugrel
22. ANTI THROMBOLYTIC
1) STREPTOKINASE (STREPTASE)
Therapeutic category: Thrombolytic agent
Mode of action
Create an active complex which promote the
cleavage of the Arg/Val bond in plasminogen to form
proteolytic enzyme plasmin
Plasmin degrade the fibrin matrix of the thrombus
thereby exerting its thrombolytic action
23. Streptokinase contd
Route of administration: IV, Intracoronary
Indications
Deep vein thrombosis, pulmonary embolism
Acute occlusion of peripheral arteries, acute MI
Dosage: 250,000 iu then, 100,000iu/hr for 24-72hrs
24. Streptokinase contd
Side effects
Hypotension, anaphylaxis (rare)
Minor bleeding from puncture site, arrhythmia
Contra indications
Severe liver or kidney damage, intracranial neoplasm
CVA, hemorrhagic diathesis, severe hypertension
Uncontrolled clotting disorders
Recent surgery, bleeding tendency, pregnancy
25. Streptokinase contd
Nursing responsibilities
Obtain haemostatic status of the patient and exclude
pericarditis before starting therapy
Monitor PTT, PT, Hgb, Hct
Give slowly to prevent hypotension
Monitor for symptoms of allergy
Other thrombolytic agents includes: Alteplase,
Reteplase, and Tenecteplase.
26. EXERCISE
The client begins vomiting blood. Which of the
following medications should the Nurse give to revert
the effect of HEPARIN SODIUM
a) Vit K b) Atropine sulphate c) Protamine sulphate
d) Calcium gluconate
27. Exercise
A Nurse is caring for client following thrombolytic
therapy. Which of the following interventions should
the Nurse implement to help reduce bleeding?.
(Select all that apply)
a) Avoid IM or IV Injection b) Administer lasix
c) Apply pressure to bleeding puncture site
d) Reduce the maintenance of IVF rate
28. Exercise
When caring for a client taking aspirin. To reduce the
risk for myocardial infarction, the Nurse should
monitor for which of the following adverse effect?
(Select all that apply)
a) Coffee grounded emesis b) Hypertension
c) Black tarry stool d) Bradycardia
