Question

Sandra is a 27-year-old female admitted with a possible Deep Vein Thrombosis (DVT). She smokes one pack per day and is on birth control. She has a history of hypertension and obesity. She is admitted to the hospital and placed on bedrest. Heparin drip is started per protocol. The Provider is anticipating on sending her home with Coumadin.

Can Sandra be placed on Coumadin and Heparin at the same time? Explain your answer.

Develop 3 teaching points important for Sandra to know about her medications regimen.

Teach Back is a great way to find out about patient teaching effectiveness. Watch the following video for an example of Teach Back

What questions would you ask Sandra to verify that she understand the 3 teaching points?

Answer 1

Yes, Sandra can be placed on coumadin and heparin at the same time. Heparin is given intravenously and coumadin is given orally. Both are anticoagulants but act differently. Heparin prevents formation of clots and coumadin manages the clots. Heparin is used for immediate response while coumadin is for long term treatment. Heparin starts working within 20 to 60 minutes and lasts for 8 to 12 hours, coumadin is effective after 12 to 24 hours and peaks at about 1.5 to 4 days and remains active for 3 to 5 days. For this reason the patient is put on heparin first and then simultaneously on coumadin until the coumadin therapeutic value is reached.

The three teaching points regarding the therapy are:

• Don't smoke or drink alcohol. Smoking causes blood clots and cardiovascular disease. While drinking alcohol will reduce the effectiveness of anticoagulant drugs.
• Avoid medications like aspirin, NSAIDS, multivitamins with vitamin K, fish oil and antibiotics. Avoid taking high dosage of vitamin K.
• Avoid doing any activity that causes bleeding such as pricking nose, blowing of nose, using toothpicks or sharp instruments, etc.