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CHAPTER 53
Cardiovascular Medications
Priority Concepts
Clotting; Perfusion
I. Anticoagulants (Box 53-1)
A. Description
1. Anticoagulants Prevent The Extension And
Formation Of Clots By Inhibiting Factors In
The Clotting Cascade And Decreasing Blood
Coagulability.
2. Anticoagulants Are Administered When There Is
Evidence Of Or Likelihood Of Clot Formation
— Myocardial Infarction, Unstable Angina,
Atrial Fibrillation, Deep Vein Thrombosis,
Pulmonary Embolism, And The Presence Of
Mechanical Heart Valves.
. Anticoagulants Are Contraindicated With Active
Bleeding (Except For Disseminated
Intravascular Coagulation), Bleeding
Disorders Or Blood Dyscrasias, Ulcers, Liver
And Kidney Disease, And Hemorrhagic Brain
Injuries (Box 53-2).
B. Side And Adverse Effects
. Hemorrhage
2.Hematuria
3.Epistaxis
4.Ecchymosis
5.Bleeding Gums
6.Thrombocytopenia
7.Hypotension
C. Heparin Sodium
1. Description
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a. Heparin Prevents Thrombin
From Converting Fibrinogen To
Fibrin.
b.Heparin Prevents
Thromboembolism.
C. The Therapeutic Dose Does Not
Dissolve Clots But Prevents New
Thrombus Formation.
2. Blood Levels
A. The Normal Activated Partial
Thromboplastin Time (Aptt) Is 30
To 40 Seconds (Conventional And
SI Units) In Most Laboratories
(Values Depend On Reagent And
Instrumentation Used).
B. To Maintain A Therapeutic Level
Of Anticoagulation When The
Client Is Receiving A Continuous
Infusion Of Heparin, The Aptt
Should Be 1.5 To 2.5 Times The
Normal Value. Some Agencies
Use 2 Different Protocols, A
Highintensity Protocol Such As
For Acute Coronary Syndrome
And A Lowintensity Protocol
Such As For Venous
Thromboembolism Prophylaxis,
And The Dosages And
Recommended Aptt
Ranges Are Slightly Different For
The Two Protocols.
c. Activated Partial
Thromboplastin Time
Therapy Should Be Measured
Every 4 To 6 Hours During Initial
Continuous Infusion Therapy Or
Until The Client Has Been
Therapeutic For A Specified Time
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Frame And Then Daily Per
Agency Policy.
d. If The Aptt Is Too Long, Per
Agency Procedure, The Dosage
Should Be Lowered.
e. If The Aptt Is Too Short,
Per
Agency Procedure, The Dosage
Should Be Increased.
3. Interventions
a. Monitor Aptt.
b. Monitor Platelet Count.
c. Observe For Bleeding Gums,
Bruises,
Nosebleeds, Hematuria,
Hematemesis, Occult Blood In
The Stool, And Petechiae.
d. Instruct The Client Regarding
Measures
To Prevent B Eeding.
E. The Antidote To Heparin Is
Protamine Sulfate.
F. When Administering Heparin
Subcutaneously, Inject Into The
Abdomen With A ⅝-Inch (16-Mm)
Needle (25 To 28 Gauge) At A 90-
Degree Angle And Do Not
Aspirate Or Rub The Injection
Site.
G. Continuous IV Infusions Must
Be Run On An Infusion Pump To
Ensure A Precise Rate Of
Delivery.
D. Enoxaparin Or Rivaroxaban—Low-Molecular-Weight
Heparins
1.Description: Enoxaparin And Rivaroxaban
Have The Same Mechanism Of Action And Use
As Heparin But Are Not Interchangeable With
Heparin; They Have Longer Half-Lives Than
Heparin Does.
2.Interventions
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A. Administer Enoxaparin Only To
The Recumbent Client By
Subcutaneous Injection Into The
Anterolateral Or Posterolateral
Abdominal Wall; Do Not Expel
The Air Bubble From The
Prefilled Syringe Or Aspirate
During Injection.
b.Rivaroxaban Is A Taken Orally,
Once Daily.
c. Monitor Results Of The Anti-Xa
Assay. The Therapeutic Range For
Anticoagulation Is 0.5 To 1.2
IU/Ml (Conventional And SI
Units). Observe For Bleeding.
D. The Antidote To Low-Molecular-
Weight Heparins Is Protamine
Sulfate.
E. Warfarin Sodium
1.Description
a. Warfarin Suppresses Coagulation
By Acting As An Antagonist Of
Vitamin K By Inhibiting 4
Dependent Clotting Factors (X, IX,
VII, And II).
b.Warfarin Prolongs Clotting Time
And Is Monitored By The
Prothrombin Time (PT) And The
International Normalized Ratio
(INR).
1768
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CHAPTER 53
Cardiovascular Medications
Priority Concepts
Clotting; Perfusion
I. Anticoagulants (Box 53-1)
A. Description
1. Anticoagulants Prevent The Extension And
Formation Of Clots By Inhibiting Factors In
The Clotting Cascade And Decreasing Blood
Coagulability.
2. Anticoagulants Are Administered When There Is
Evidence Of Or Likelihood Of Clot Formation
— Myocardial Infarction, Unstable Angina,
Atrial Fibrillation, Deep Vein Thrombosis,
Pulmonary Embolism, And The Presence Of
Mechanical Heart Valves.
. Anticoagulants Are Contraindicated With Active
Bleeding (Except For Disseminated
Intravascular Coagulation), Bleeding
Disorders Or Blood Dyscrasias, Ulcers, Liver
And Kidney Disease, And Hemorrhagic Brain
Injuries (Box 53-2).
B. Side And Adverse Effects
. Hemorrhage
2.Hematuria
3.Epistaxis
4.Ecchymosis
5.Bleeding Gums
6.Thrombocytopenia
7.Hypotension
C. Heparin Sodium
1. Description
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a. Heparin Prevents Thrombin
From Converting Fibrinogen To
Fibrin.
b.Heparin Prevents
Thromboembolism.
C. The Therapeutic Dose Does Not
Dissolve Clots But Prevents New
Thrombus Formation.
2. Blood Levels
A. The Normal Activated Partial
Thromboplastin Time (Aptt) Is 30
To 40 Seconds (Conventional And
SI Units) In Most Laboratories
(Values Depend On Reagent And
Instrumentation Used).
B. To Maintain A Therapeutic Level
Of Anticoagulation When The
Client Is Receiving A Continuous
Infusion Of Heparin, The Aptt
Should Be 1.5 To 2.5 Times The
Normal Value. Some Agencies
Use 2 Different Protocols, A
Highintensity Protocol Such As
For Acute Coronary Syndrome
And A Lowintensity Protocol
Such As For Venous
Thromboembolism Prophylaxis,
And The Dosages And
Recommended Aptt
Ranges Are Slightly Different For
The Two Protocols.
c. Activated Partial
Thromboplastin Time
Therapy Should Be Measured
Every 4 To 6 Hours During Initial
Continuous Infusion Therapy Or
Until The Client Has Been
Therapeutic For A Specified Time
1768
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Frame And Then Daily Per
Agency Policy.
d. If The Aptt Is Too Long, Per
Agency Procedure, The Dosage
Should Be Lowered.
e. If The Aptt Is Too Short,
Per
Agency Procedure, The Dosage
Should Be Increased.
3. Interventions
a. Monitor Aptt.
b. Monitor Platelet Count.
c. Observe For Bleeding Gums,
Bruises,
Nosebleeds, Hematuria,
Hematemesis, Occult Blood In
The Stool, And Petechiae.
d. Instruct The Client Regarding
Measures
To Prevent B Eeding.
E. The Antidote To Heparin Is
Protamine Sulfate.
F. When Administering Heparin
Subcutaneously, Inject Into The
Abdomen With A ⅝-Inch (16-Mm)
Needle (25 To 28 Gauge) At A 90-
Degree Angle And Do Not
Aspirate Or Rub The Injection
Site.
G. Continuous IV Infusions Must
Be Run On An Infusion Pump To
Ensure A Precise Rate Of
Delivery.
D. Enoxaparin Or Rivaroxaban—Low-Molecular-Weight
Heparins
1.Description: Enoxaparin And Rivaroxaban
Have The Same Mechanism Of Action And Use
As Heparin But Are Not Interchangeable With
Heparin; They Have Longer Half-Lives Than
Heparin Does.
2.Interventions
1768
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l
A. Administer Enoxaparin Only To
The Recumbent Client By
Subcutaneous Injection Into The
Anterolateral Or Posterolateral
Abdominal Wall; Do Not Expel
The Air Bubble From The
Prefilled Syringe Or Aspirate
During Injection.
b.Rivaroxaban Is A Taken Orally,
Once Daily.
c. Monitor Results Of The Anti-Xa
Assay. The Therapeutic Range For
Anticoagulation Is 0.5 To 1.2
IU/Ml (Conventional And SI
Units). Observe For Bleeding.
D. The Antidote To Low-Molecular-
Weight Heparins Is Protamine
Sulfate.
E. Warfarin Sodium
1.Description
a. Warfarin Suppresses Coagulation
By Acting As An Antagonist Of
Vitamin K By Inhibiting 4
Dependent Clotting Factors (X, IX,
VII, And II).
b.Warfarin Prolongs Clotting Time
And Is Monitored By The
Prothrombin Time (PT) And The
International Normalized Ratio
(INR).
1768
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