Heparin Similarities Warfarin (Coumadin)

Family Indirect Thrombin anticoagulants Vitamin K antagonist

Inhibitors

MOA Enhances activity of  Slows down the Inhibit clotting factors

antithrombin III, clotting process from using Vitamin K
Inhibits thrombin, this  Does not break/lysis a
stops the conversion of clot
fibrinogen  fibrin  Used to prevent or tx
blood clots
Works on the intrinsic pathway of extrinsic pathway
coagulation

Onset Fast  Used together to help Slow

bridge for long-term
Warfarin

Duration Hours  Days

(3-5 days) for

therapeutic effect

Administration Injection: Sub Q  NO NSAIDS, ASA, OTC Orally

HERBALS
IV (continuous) These can effect Same time everyday
bleeding times
Weight based If dose was missed:
 No contact sports
 Electric razors/soft If remembered same
bristled toothbrush day, take dose
 S/S of bleeding, like
gums, urine, stool, If remembered next
vomiting day,
 Avoid IM injections Skip previous dose due
that day, write it down,
consult MD
Monitor aPTT PT/INR
Activated Partial
Thromboplastin Time INR is calculated from
PT level
 Antidote Protamine Sulfate Vitamin K

Used Short term Long term

Can be used yes No

during pregnancy

Side effects Heparin-Induced DIET:

Thrombocytopenia Normal diet
 Platelets and Avoid excessive intake
new/worsening of green leafy
clot vegetable (this will
decrease INR level)
OSteoporis
 Those on heparin No alcoholic beverages
long term or in
high dose
 Affects
osteoblasts/clasts
activity

Antagonist

 work against

Antithrombin III

 naturally occurring substance

Intrinsic pathway of coagulation

 activated whenever there is internal trauma to the vascular system

Vitamin K

 Used in the liver to make clothing factors

Extrinsic pathway

 Activated when there is external trauma

Administering Heparin Sub Q

  Fatty tissue
 2 inches away from navel
 1 inch away from scars
 Rotate injection sites
 Don’t massage or rub

aPTT

 Normal
o 30-40 seconds
 Therapeutic
o 1.5-2.5 seconds x normal
o 60-80 seconds

INR, calculated from PT

 Normal: 0.75-1.25
 Therapeutic: 2-3

Heparin-Induced Thrombocytopenia

 Antibodies produced against heparin, attach the platelet factor 4 and heparin, causing a drop of
platelet