Heparin (Anticoagulant)

Tags anticoagulants

Free https://www.registerednursern.com/heparin-nclex-questions-
Quiz Link anticoagulation/

Lecture
notes

• Venous thromboembolism (VTEs) • Pulmonary Embolism (PE) •

Treatment Stroke (certain types) • Atrial fibrillation (erratic heart impulses lead the
for: heart not to empty fully and blood can pool, which forms a clot) • Clot
prevention with certain surgeries

Video https://youtu.be/L_9OPbqxbmU?
Lecture list=PLQrdx7rRsKfWpel1Ymwd9IQe0noyzAjeS

HEPARIN
anticoagulant that is used to treat and/or prevent blood clots

part of the indirect thrombin inhibitors family, and it’s an anticoagulant

Heparin indirectly inhibits thrombin

by affecting the intrinsic pathway of clotting

this pathway is normally activated by internal vascular trauma

it does this by enhancing the activity of antithrombin III ( a natural substance in

our body) this substance inactivates enzymes that play a role in the clotting
process

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 when it is activated (antithrombin III) it will prevent the activation of
thrombin (which converts fibrinogen to fibrin)

therefore, what’s happening is that this medication, Heparin, is binding with this
natural substance (antithrombin III) in our body and amplifying how it works.

result: slows down the clotting process and helps prevent blood clots

when coagulation occurs abnormally, a venous thromboembolism (VTE) can occur

there are two types of these:

deep vein thrombosis (DVT)

where a clot forms within a vessel

can break off and travel in circulation and when it does this it is known
as an embolism

embolism

pulmonary embolism - most common type of embolism that can happen

where the DVT broke off and travelled into circulation where it went
to the lungs

an embolism can also cause a stroke or heart attack

Note:

Anticoagulants do not dissolve or break up the clot.

They just prolong how long it takes the blood to clot.

Used for
Preventing or treating blood clots

What kind of conditions can benefit from Heparin?

Preventing or treating VTEs or PE (pulmonary embolism)

Stroke (certain types)

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 Atrial fibrillation (erratic heart impulses lead the heart not to empty fully and blood
can pool, which forms a clot)

Clot prevention with certain surgeries

example: cardiac or hip

Nursing Responsibilities
administered subcutaneous or intravenous via a continuous infusion:

given continuous IV

patient will be on a Heparin drip protocol with specific guidelines to follow

based on the patient’s aPTT level (aPTT: activated partial thromboplastin
time)

aPTT will be drawn every 4-6 hours depending on the protocol

the Heparin drip will be titrated base on the aPTT.

example:

too low aPTT = patient may need a bolus of Heparin and the drip rate
increased

too high aPTT = patient may need the drip turned off for 1 hour and the
drip rate decreased

within the therapeutic range aPTT = there is no change to the drip until
the next lab draw for the aPTT

Heparin is weight-based: the nurse will need to obtain a current and accurate weight
on the patient’s so proper dosing can be administered.

PTT vs aPTT?
both measure the same thing but aPTT has an activator added to it to speed up the
clotting time for the test

therefore, it has a more narrow range than a PTT.

Heparin (Anticoagulant) 3
 blood test that measures the intrinsic and common pathways of the coagulation
process

it will assess how long it takes for certain coagulation factors to work to make a
clot

measured in seconds and a normal range for the aPTT is 30-40 seconds (ranges
slightly vary based on the lab).

remember in order for Heparin to work (hence prevent clots) the patient has to be
THERAPEUTIC with their aPTT

Heparin therapeutic range for the aPTT: 1.5-2.5 times (normal value range)

example: 60-80 seconds (approximate range, varies on protocol and labs)

What to remember?

aPTT less than 60

patient is not therapeutic (may need bolus and rate increased)

aPTT greater than 80

patient is at risk for bleeding (drip may be stopped for an hour (Heparin has a
short half-life) and then it may be restarted at a lower rate)

if administered subcutaneous, know how to give it and where

site: fatty tissue of the abdomen, stay at least 2 inches away from the belly
button and 1 inch away from scars (won’t absorb the medication)

always rotate sites (see where the last nurse administered the injection in the
chart and ask the patient)

don’t rub or massage the area!

monitor for bleeding (in unusual places):

oozing at the gums

dark, tarry stool “melena”

positive stool guaiac

reddish, pink urine “Hematuria”

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 vomiting blood or coffee ground appearance “hematemesis”

bruising for no cause

nosebleeds

tachycardia and hypotension

severe headache (bleeding in brain)

monitor CBC (hbg and hct)

monitor for Heparin-induced Thrombocytopenia (HIT):

body makes antibodies against the Heparin because it’s binding to platelet
factor 4 (a blood protein)

created antibodies will bind to the Heparin and PF4 complex, which activates
the platelets

small clots will form (hence new clots or worsening of current clots) and
the platelet count falls, hence thrombocytopenia.

monitor:

CBC (platelets, hgb, and hct)

signs and symptoms of new clot formation (signs and symptoms vary
depending on clot location)

red, swollen, hard areas

chest pain

shortness of breath etc.

What happens if this develops?

Heparin discontinued and started on direct thrombin inhibitors (argatroban,

bivalirudin etc.)

be familiar with the antidote for Heparin, which is protamine sulfate

avoid IM injections, pick another route and hold firm, direct pressure after drawing
blood (remember the patient bleeds easily)

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 some patients will be started on Warfarin for long-term anticoagulation

warfarin takes 3-5 days for the patient to become therapeutic

so, the patient may be on Heparin too until the INR level is therapeutic, and then
once the INR is therapeutic the Heparin is discontinued

Heparin can used in pregnancy, Warfarin cannot!

Side Effects
Other side effects beside excessive bleeding, HIT:

Osteoporosis:

Heparin can stimulate osteoclasts and inhibit osteoblast activity, which affects
the strength of the bones

tends to happen with long-term/high doses of Heparin usage

other signs and symptoms:

hair loss

rashes

Health Education
teach the patient to monitor for signs and symptoms of excessive bleeding.

use soft bristle toothbrush and electric razors.

avoid contact sports.

tell all care providers that you’re on Heparin, especially prior to any procedures.

do not take ASA or NSAIDs (increases risk of bleeding) or OTC health supplements
without speaking to doctor

how to administer subq heparin, if taking this route.

if patient has an accident that causes bleeding or has blood drawn etc., they will
need to hold firm direct pressure.

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