1. Chapter 19 Agents Affecting Blood Clotting

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 2 Blood Clotting Thromboemboli  Cause many deaths per year Anticoagulants  Prevent the formation of coagulants

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 3 Anticoagulant Agents Inhibit the formation of clots  Heparin  Found in mast cells  Action  Inhibit the clotting process

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 4 Heparin Heparin action  Indirectly interferes with the conversion of prothrombin to thrombin  The deficiency of thrombin prevents the conversion of fibrinogen to fibrin (continues)

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 5 Heparin Destroyed if given orally Administered via IV infusion  No intramuscular injections Administered subcutaneously  Longer acting form  No intramuscular injections (continued)

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 6 Heparin: Side Effects Hemorrhage Allergy Antidote  Protamine sulfate Caution  Do not administer to clients with coagulation disorders

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 7 Low Molecular Weight Anticoagulant Related to heparin  Minor risk for bleeding Does not affect the action of thrombin in the clotting cascade (continues)

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 8 Low Molecular Weight Anticoagulant Example: enoxaparim (Lovenox) (continued)

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 9 Oral Anticoagulants Warfarin (Coumadin)  Inhibits blood clotting by interfering with the synthesis of vitamin K-dependent clotting factors Close client monitoring  Dosage is individualized  International normalized ratio

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 10 Antiplatelet Agents Action: inhibit the aggregation of platelets  Treat clients who have had cerebrovascular accidents or myocardial infarctions

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 11 Antiplatelets Examples  Aspirin  Abciximab (ReoPro)  Clopidogrel bisulfate (Plavix)

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 19 - 12 Thrombolytic Agents Action  Convert plasminogen to enzyme fibrinolysin; fibrinolysin dissolves clots Example  Streptokinase (IV) Caution  Hemorrhage