DRUGS AFFECTING BLOOD

COAGULATION
> Works at various steps in the clotting and clot
dissolving process in order to restore the balance
that is needed to maintain the cardiovascular system

 ANTICOAGULANTS – drugs that

interfere with the normal
coagulation process
 ANTIPLATELET- alter the formation
of platelet plug
 THROMBOLYTICS- break down the
thrombus that has been formed by
stimulating the plasmin system
Mechanisms of Blood coagulation

1. Vascular Response
 Platelets release serotonin causing
vasoconstriction
2. Platelet Aggregation
 Platelets form a mechanical barrier or wall
to close off the break in the capillary
3. Chemical clotting
 Release of clotting factors
CLOTTING FACTORS

I. Fibrinogen
II. Prothrombin

III. Tissue factor

IV. Calcium ions

V. Proaccelerin

VII. Serum prothrombin conversion

accelerator
VIII.Anti-hemophilic factor A
IX. Christmas factor; antihemophilic
factor B
X. Stuart factor; thrombokinase

XI. Plasma
thromboplastin/antihemophilic
factor c
XII. Hogeman factor; antihemophilic D

XIII.Fibrin stabilizing factor

 Clots – prevent blood loss
 Clotting- chain of reaction stimulated by
the release of a chemical called
thromboplastin from injured cells.
THROMBOPLASTIN
↓
Acts on PROTHROMBIN & causes it to be converted into
its active form
THROMBIN
↓
Acts on another blood protein
FIBRINOGEN
↓
When activated, it is converted to FIBRIN
↓
 Fibrin web forms a plug that stops flow of blood to
tissues
↓
Platelet thromboplastin ( reinforcing fibrin network)
↓
CLOT
↓
Dissolved by a blood – borne enzyme
(PLASMIN)
↓
Plasmin digests the thread of fibrin by first making them
soluble &
break them into small fragments
 ANTICOAGULANTS
1. WARFARIN (COUMADIN)
- works by interfering the formation of vitamin K –
dependent clotting factors and prolongation of
clotting times
- PO, onset 3 days, duration 4-5 days
- Uses: AF, artificial heart valves, prevent thrombus
and embolization affecting MI and pulmonary
embolism
- ANTIDOTE: phytonadione (Aquamephyton)- a form
of vitamin K ( responsible for promoting the liver
synthesis of clotting factors)
- LAB: prothrombin time (PT) – maintained at 1.25 –
2.5 times the laboratory control value
: International Normalized Ratio (INR)= 2-3
2. HEPARIN

- naturally occurring substance that inhibits

the conversion of prothrombin to thrombin ,
thus blocking the conversion of fibrinogen
to fibrin which is the final step of clot
formation

- SQ, IV, immediate onset, does NOT cross

the placenta and NOT enter the breast milk

- Uses: treatment and prevention of venous

thrombosis and pulmonary embolism , AF
with embolization, prevemt clotting of blood
samples in dialysis and venous tubing.
Antidote: overdose: protamine sulfate –
strongly basic CHON drug forms stable
salts with heparin as soon as the two
drugs come in contact immediately
reversing the effect of heparin
( paradoxically: anticoagulant effect if
not with heparin)

LAB:
• whole blood clotting time (WBCT) 2.5- 3
X control
• Activated Partial Thromboplastin Time
(aPTT) upto 40 sec
• Partial Thromboplastin time (PTT) 1.5-
2.5 X control in secs.
 CI: hypersensitivity, bleeding tendencies,
psychosis, diarrhea ( loss of vitamin K or
plasminogen)
 AE: bleeding, warfarin = alopecia,
dermatitis, prolonged & painful erections
(less frequent)
 DI: Heparin +( aspirin, NSAID,
thrombolytics)= increase effect
Heparin + (nitroglycerine, protamine)
= decrease effect
Warfarin + (aspirin, NSAIDs, sulfonamides)
= increase effect
warfarin + (oral contraceptives,phenytoin,
rifampin = decrease effect
warfarin + alcohol = increase bleeding
 NURSING CONSIDERATIONS:

 Avoid large amount of green leafy

vegetables, fish, liver, coffee and tea;
NO alcohol
 Evaluate therapeutic levels
 Sigs of bleeding
 Safety precautions (electric razor, avoid
contact sports, use pressure dressing,
NO IM injection, inform dentist, soft
bristled toothbrush)
 Maintain antidote standby
 Medic alert card, do not smoke, NO
aspirin
 ANTIPLATELETS
 Uses: adjunct to thrombolytic therapy in
the treatment of MI & prevention of re-
infarct, prevention of MI and stroke
 Eg: abciximab (ReoPro), IV
: anagrelide (Agralyn),PO
: dipyridamole (Persantine), PO
: eptifibatide (Integrilin) , IV
: aspirin (generic), PO
: cilostazol (Pletaal), PO
: clopidogrel (Plavix),PO
 : sulfinpyrazone (Anturane), PO
: ticlopidine (Ticlid), PO
: tirofiban (Aggrastat), IV
CI: hypersensitivity, pregnancy,
lactaion, bleeding disorder, recent
surgery
AE: bleeding, Gi discomfort, HA
NURSING CONSIDERATIONS: (same)
 THROMBOLYTIC AGENTS
MOA: converts plasminogen to plasmin to
dissolve clot
Uses: pulmonary embolism, DVT, MI, acute
ischemic CVA
CI: severe hypertension, active bleeding,
hemophilia, thrombocytopenia, GI bleed,
hypersensitivity
DI: inc bleeding with NSAIDs, antiplatelet,
anticoagulant
SE: bleeding, rash (streptokinase), febrile
reaction, N/V, flushing, hypotension
AE: hemorrhage
 EG:
 streptokinase ( Kabikinase, Streptase)
 urokinase ( Abbokinase)
 anistreplase
 anisoylated plasminogen streptokinase
activator complex (APSAC)
 reteplase
 Alteplase (t- PA)
 tenecteplase
 NURSING ONSIDERATIONS:
 Check BP prior (defer if < / = 90/60)
 Monitor bleeding time, hgb, platelet count,
APTT
 Monitor signs of bleeding up to 24 hours post
the last dose
 Check for allergic reactions esp to
streptokinase (Benadryl may be given prior)
 IV drugs that are mixed should be used within
24 hours , infusion pump
 Avoid invasive procedure
 Apply pressure for 5-10 mins on all
discontinued IV sites
 ANTIDOTE: aminocaproic acid (Amicar)
 Prevent bleeding
 HEMOSTATIC AGENTS
 MOA: hasten clotting of blood by
inhibiting the substance that activate
plasminogen
 Uses: to stop bleeding
 CI: elevated BP, clotting disorders
 SE: increase BP ( most common), HA,
N/V, abdominal cramps diarrhea, fatigue,
muscle pain
 AE: intrarenal obstruction d/t clot
formation, anaphylaxis ( esp with
aprotinin)
 DI: aminocaproic acid + oral
contraceptives = increase coagulation
 Eg:
 Systemic hemostatic:
 Aprotinin
 Vitamin K
 Aminocaproic acid
 Cabazochrome NA
 Tranexamic acid
 somatostatin
 Topical
 Gelfilm / gelfoam
 Microfibrillar collagen
 Thrombin
 Oxidized cellulose
 NURSING CONSIDERATIONS:
 Monitor clotting time, urine output,
signs of anaphylaxis
 Leave gelfoam until bleeding stops,
remove immediately after bleeding is
controlled & wash the site to decrease
risk for infection
 Check BP prior ( defer if > 140/90)