Drug Information Table Anticoagulants – (factor Xa/thrombin inhibitors) heparin; (factor Xa inhibitor) enoxaparin (Lovenox) Therapeutic Use Administration • Anticoagulation for evolving • Measure baseline vital signs, cerebrovascular accident, CBC, platelet count, and pulmonary embolism, massive hematocrit. deep-venous thrombosis • Administer subcutaneously or • Adjunct therapy during IV, usually every 12 hr. angioplasty, open-heart • Use an infusion pump for surgery, hemodialysis, blood continuous IV administration; transfusion monitor rate of infusion every • Prophylaxis for postoperative 30 to 60 min. venous thrombosis and • Monitor aPTT every 4 to 6 hr pulmonary emboli initially, then monitor daily. • Acute myocardial infarction (Enoxaparin does not require (with thrombolytic therapy) aPTT monitoring.) • Ischemic complications of • Keep aPTT at one and a half to unstable angina and some two times the baseline value. dysrhythmias • Administer deep subcutaneous • Disseminated intravascular injections in the abdomen coagulation at least 2 inches from the umbilicus and rotating sites; apply moderate pressure for 1 to 2 min after injection, do not rub. • Make sure patients watch for and report signs of bleeding (bruising, gums bleeding, abdominal pain, nose bleeds, coffee-ground emesis, tarry stools). • Tell them not to take over-the- counter NSAIDs, especially aspirin, or drugs containing salicylates. • Advise them to use an electric razor for shaving and a soft toothbrush. Side/Adverse Effects Interventions Patient Instructions • Hemorrhage • Monitor vital signs, checking for • Report bruising, petechiae, hypotension and tachycardia. hematomas, or black tarry • Monitor activated partial stools. thromboplastin time (aPTT), making sure it is no higher than twice the baseline value. • For heparin overdose, stop heparin and administer protamine, which binds with heparin to form a heparin- protamine complex that has no anticoagulant properties. • Administer IV protamine no faster than 20 mg/min or 50 mg in 10 min. • Thrombocytopenia (low platelet • Monitor platelet count • Report calf pain, tenderness, or count) periodically throughout swelling immediately. treatment, especially in the first • Report shortness of breath. month. • Stop heparin for platelet counts below 100,000/mm3 and administer a non-heparin anticoagulant, such as lepirudin (Refludan). • Hypersensitivity reactions • Administer a small test dose • Report itching, rash or hives. first. • Monitor for itching and rash or hives • Neurological injury (from • Monitor spinal insertion site for hematoma formation during signs of hematoma formation, lumbar puncture, epidural such as bruising or swelling. anesthesia) • Monitor sensation and movement of lower extremities. Contraindications Precautions Interactions • Uncontrollable bleeding • Hemophilia • NSAIDs (especially aspirin) • Severe thrombocytopenia • Increased capillary permeability and antiplatelet drugs increase • During lumbar puncture, • Dissecting aneurysm bleeding risk. regional anesthesia, or surgery • Peptic ulcer disease • IV nitroglycerin reduces that involves the brain, eyes, or • Severe hypertension anticoagulation. spinal cord • Severe hepatic or renal disease • Protamine reverses heparin • Threatened spontaneous activity. abortion • Herbals ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding risk.