Heparin and Warfarin

Heparin

It is a quick-acting, injectable anticoagulant.

Mechanism of Action

• Acts across several sites during the coagulation process
• Forms a bond with antithrombin III
• Catalyst for thrombin and other clotting factors' inactivation

Indication

Deep vein thrombosis (DVT), thromboembolic diseases, and pulmonary embolism.

Dose

(offered as 5000 IU/mL Heparin in 5 ml vials with a total of 25,000 IU Heparin)

• Adult: 5000 SC every 8–12 hours as a preventative measure.
• Therapeutic: 5,000 units (10,000 units in cases of severe pulmonary embolism), which may be followed by a continuous IV infusion of 15 to 25 units/kg/hr that is adjusted to maintain an APTT value of 2-4 times normal.
• Child: Every 4-6 hours, 50-100 units/kg.
• Deep SC inj. may be administered.

Contraindication

Brain hemorrhage, recent surgery, severe thrombocytopenia, hemophilia

Side Effects

Increased liver enzymes, hepatitis, thrombocytopenia, haematuria, and bleeding SC injection-related skin necrosis and anaphylactic shock.

Nursing Consideration

• The remedy for an extremely anticoagulant dose of heparin is protamine sulfate. Protamine inactivates 100 units of heparin in 1 gm.
• Heparin should be dripped continuously. Never stop a heparin drip to provide another medication or IV therapy. a short half-life Therapeutic efficacy may be lost if infusion is delayed.
• Only IV or SQ7 are acceptable administration routes (does not absorb PO; IM causes hematoma)
• Bleeding danger rises. Check for contraindications in patients.
• It is necessary to regularly monitor dose and modify it in accordance with aPTT levels to lower the risk of bleeding.
• Activated thromboplastin time (aPTT), which is typically a portion of 40 seconds, should be monitored.
• 1.5–2–1 normal level (60–80 seconds) is the therapeutic target for aPTT.
• 30 minutes before to SQ or intermittent heparin dosages, draw blood for the aPTT.
• neither passes through the placental barrier during pregnancy nor into the breast milk while nursing.
• Check injection sites frequently for hematoma symptoms.
• For longer periods of time, apply direct pressure to the venipuncture sites (e.g., 3 minutes).

Warfarin

It is an anticoagulant taken orally.

Mechanism of Action

Prevents the synthesis of coagulation factors that are dependent on vitamin K.

Indication

• Anticoagulant as well as
• Vein thrombosis and pulmonary embolism prevention and care
• embolization and atrial fibrillation
• After the installation of a prosthetic valve, thrombus development and embolization are prevented, etc.

Dose

(Available as 1 mg, 2 mg, and 5 mg Warfarin pills)

According to the patient's condition and coagulation tests, the first dose is 5 mg per day, and the maintenance dose ranges from 1 mg to 10 mg per day.

Contraindication

Hepatic diseases

Side Effects

Syncope, mouth bleeding, mouth ulceration, gangrene, hepatitis, anaphylaxis, and sore.

Nursing Consideration

• Tell the patient to take their medication as the doctor has prescribed.
• Before beginning therapy, determine PT/INP. When starting treatment, every day, when adding or stopping an interfering medication, and every 4-6 weeks after the patient is stabilized, monitor PT.
• Maintain PT ratios of 1.3–1.5, 1.5–2, and 3-4.5 with mechanical prosthetic valves or recurrent systemic emboli, respectively, and INR ratios of 2–3, 3-4,5.
• Review the vitamin K-rich foods. As vitamin K is the antidote for warfarin and alternating intake of these foods will cause PT levels to fluctuate, the patient should have a consistent, moderate intake of these foods.
• During treatment, tell the patient to stay away from cranberry products and juice.
• When the danger of hemorrhage outweighs the potential clinical benefits, it is contraindicated.
• Patient should be warned to stay away from IM injections and risky activities. Inform the patient that while taking warfarin, they should not floss and should only shave with an electric razor.
• Inform the patient that pressure must be applied to injection and venipuncture sites to stop bleeding and hematoma formation.
• Encourage the patient to tell their doctor right away if they experience any symptoms of unusual bleeding or bruising, as well as any changes in pain, color, or body temperature.
• Don't allow the patient to consume alcohol or take NSAIDs like aspirin.
• Encourage the patient to let the doctor know if she is planning a pregnancy, suspecting one, or nursing a baby.
• Never stop taking any medication without first talking to your doctor.