Question

Medications affecting coagulation

	Coumadin	Heparin	Lovenox
Mode of Action
Indications
Dosage/Route
Side Effects
Labs to Monitor
Antidote
Patient teaching

Answer 1

	Coumadin	Heparin
Mode of Action	It produces its anticoagulant affect by interfering with the Vitamin K cycle.	Heparin exerts parts of its anticoagulant activity through interaction with antithrombin antithrombin binds specifically to a pentsaccharide in heparin binding to heparin induced a conformational change in the antithrombin, which accelerate enzyme inhibition
Indication	Prophylaxis and treatment of Venous thrombosis, Pulmonary embolism, thromboembolic complications associated with atrial fibrillation (AF) and/or cardiac valve replacement. Reduction in the risk of death, recurrent myocardial infarction (MI), and stroke.	Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation); Prevention of clotting in arterial and heart surgery. Prophylaxis and treatment of Venous thrombosis, Pulmonary embolism, thromboembolic complications associated with atrial fibrillation (AF) and/or cardiac valve replacement. Reduction in the risk of death, recurrent myocardial infarction (MI), and stroke.
Dosage and Route	Tablet / Oral route – 1mg,2mg,2.5mg,3mg,4mg,5mg,6mg,7.5mg and 10 mg Injection/ Intravenous route: 5 mg, lyophilized powder in a single-dose vial.	Heparin sodium is not effective by oral administration and should be given by intermittent intravenous injection, after dilution in 50 or 100 mL of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP, or by intravenous infusion.
Side effects	Hemorrhage, Hypersensitivity, Tissue Necrosis, Calciphylaxis ,Acute Kidney Injury , Limb Ischemia, Necrosis, and Gangrene Immune system disorders: hypersensitivity/allergic reactions (including urticaria and anaphylactic reactions) Vascular disorders: vasculitis Hepatobiliary disorders: hepatitis, elevated liver enzymes. Cholestatic hepatitis Gastrointestinal disorders: nausea, vomiting, diarrhea, taste perversion, abdominal pain, flatulence, bloating Skin disorders: rash, dermatitis, pruritus, alopecia	Hemorrhage, Hypersensitivity, thromboembolic complications such as skin necrosis, gangrene of the extremities that may lead to amputation, myocardial infarction, pulmonary embolism, stroke and possibly death. Cardiovascular — Subacute bacterial endocarditis. Severe hypertension. Surgical — During and immediately following (a) spinal tap or spinal anaesthesia or (b) major surgery, especially involving the brain, spinal cord or eye. Hematologic — Conditions associated with increased bleeding tendencies, such as haemophilia, thrombocytopenia, and some vascular purpuras. Gastrointestinal — Ulcerative lesions and continuous tube drainage of the stomach or small intestine. Other — Menstruation, liver disease with impaired haemostasis.
Labs to monitor	Complete blood picture	SGOT,SGPT Periodic platelet counts, hematocrits and tests for occult blood in stool are recommended during the entire course of heparin therapy
Antidote	Oral or Parenteral Vitamin K1	Protamine sulfate (1% solution) by slow infusion will neutralize heparin sodium. No more than 50 mg should be administered, very slowlyin any 10 minute period. Each mg of protamine sulfate neutralizes approximately 100 USP heparin units.
Patient Teaching	Instruct the patient to Inform if any side effects are present Have regular blood tests Take Coumadin as prescribed If missed a dose, take it immediately on the same day. Do not take double dose on the next day Do not perform any activity that can cause injury Inform if pregnant	Instruct the patient to Inform if fever is present and any side effects are present Have regular blood tests Do not perform any activity that can cause injury Inform if pregnant, Nursing