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Chapter 19Chapter 19

Hematologic Products

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Chapter 19

Lesson 19.1

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Learning ObjectivesLearning Objectives

• Describe the influence of anticoagulants on blood clotting

• Develop a teaching plan for patients taking anticoagulants on a long-term basis

• Identify drugs that act in the formation, repair, or function of red blood cells

• Identify at least three adverse reactions associated with hematologic products.

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AnticoagulantsAnticoagulants

Two Categories– Coumarin and indandione derivatives

• – Limit the formation of blood coagulation factors II, VII, IX, and X in the liver by interfering with vitamin K

– Heparin sodium• – Increases the action of antithrombin III

(heparin cofactor) on several other coagulation factors to slow new clot development

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Anticoagulants (cont.)Anticoagulants (cont.)

Action and Uses• Prevent new thrombus formation• Stop existing thrombi from growing in size• Prophylactic: postsurgery involving the heart or

circulatory system• Patients with heart valve disease, some

dysrhythmias, and receiving hemodialysis• Patients on prolonged bed rest or with a history

of thrombus formation

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Anticoagulants (cont.)Anticoagulants (cont.)

Adverse Reactions• Warfarin (Coumadin): alopecia, rash, urticaria,

cramping, diarrhea, intestinal obstruction, nausea, paralytic ileus, vomiting, excessive uterine bleeding, hemorrhage, leukopenia, fever

• Heparin sodium: hypertension, headache, hematoma, conjunctivitis, tearing of eyes, rhinitis, hemorrhage, thrombocytopenia, dyspnea, chills, fevers, alopecia, persistent or prolonged erection, hypersensitivity

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Anticoagulants (cont.)Anticoagulants (cont.)

Drug Interactions

Nursing Implications and Patient Teaching• Calculation procedure of heparin critical• Monitoring blood values

– Coumadin = prothrombin time (PT); therapeutic is 1.5 to 2.5 × normal or an INR of 2.0 to 3.0

– Heparin = activated partial thromboplastin time (aPPT); therapeutic is 2.5 to 3 × the control value

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Anticoagulants (cont.)Anticoagulants (cont.)

• Nursing Process– Assessment– Diagnosis

– Planning

– Implementation

– Evaluation

• Patient and Family Teaching

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Protamine SulfateProtamine Sulfate

Action• Strong, alkaline protein that neutralizes effects of

heparin• Results immediate, last 2 hours or more

Uses• Treatment of heparin overdosage• After surgical procedure where heparin was used

Adverse Reactions

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Thrombolytic AgentsThrombolytic Agents

Action• Convert plasminogen to the enzyme plasmin,

which breaks down fibrin clots, fibrinogen, and other plasma proteins

Uses• Acute myocardial infarctions• Acute pulmonary emboli• Acute ischemic stroke• Acute arterial occlusion

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Antiplatelet AgentsAntiplatelet Agents

Action• Inhibit platelet aggregation (clumping)• Reduce thrombus formation

Uses• Salicylic acid (aspirin)

– Reduces incidence of myocardial-infarction-related deaths in men over 50

– Drug of choice in ischemic stroke

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Antiplatelet Agents (cont.)Antiplatelet Agents (cont.)

Uses (cont.)• Dipyridamole (Persantine), ticlopidine (Ticlid),

clopidogrel (Plavix)– Myocardial prophylaxis for men– Adjunctive therapy with thrombolytics to prevent an

infarction or stroke

• Abciximab (ReoPro), anagrelide (Agrylin)– During cardiac catheterization and cardiac

procedures