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Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)

Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)

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Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT)

 

Definition/Etiology:

  • N/A

 

Pathophysiology:

  • Medication-induced coagulopathies
    • Coumadin
    • Platelet inhibitors
    • Heparin

 

Noticing: Assessment & Recognizing Cues:

  • Bleeding
    • Bruising
    • Petechiae
    • Hematoma

 

Interpreting: Analyzing & Planning:

  • Complete Blood Count
    • Red Blood Cells
    • Hemoglobin
    • Hematocrit
    • Platelets 
  • Coagulation panel
    • PT/INR
    • PTT
    • Anti Xa level
  • Rule of “10”
    • 10 letters= coumadinpt
    • 10 letters=heparinptt

 

Responding: Patient Interventions & Taking Action:

  • Platelet inhibitors= stop; platelet infusion
  • Coumadin= vitamin K
  • Heparin = protamine sulfate
  • HIT= Direct thrombin inhibitor

 

Reflecting: Evaluating Patient Outcomes:

  • Bleeding minimized/stopped
  • Dose/type of medication adjusted
  • Education: s/s for bleeding

 

Linchpins (Key Points):

  • Rule of 10s
  • Coumadin= PT/INR; Vitamin K
  • Heparin= PTT; protamine sulfate
  • HIT=direct thrombin inhibitor
  • Antiplatelet= Plt; stop

 

 

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Transcript

References

  • Baroletti, S. A. & Gladhaber, S. Z. (2006). Heparin-induced thrombocytopenia. Circulation, 114, e355-e356. doi: 10.1161/CIRCULATIONAHA.106.632653.
  • Patriquin, C. & Crowther, M. (2011). Treatment of warfarin-association coagulopathy with vitamin K.  Expert Review of Hematology, 4(60), 657-667. doi: 10.1586/ehm.11.59.
  • Kamath, P. S. (2022). Management of antiplatelet agents in patients undergoing endoscopic procedures. https://www.uptodate.com/contents/management-of-antiplatelet-agents-in-patients-undergoing-endoscopic-procedures.

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