Nursing Responsibilities with Anticoagulant Therapy
| Heparin | Warfarin (Coumadin) | Low-Molecular-Weight Heparin (LMWH) | |
|---|---|---|---|
| Monitor | PTT (25–38 sec) (2–3 times baseline) | PT (11–15 sec) (1½–2½ times baseline) INR: 2–3.5 | Anti–factor Xa, CBC, platelets |
| Inspect | Ecchymosis, bleeding gums, petechiae, hematuria | Bleeding, ecchymosis | Bleeding, hemorrhage, unusual bruising |
| Administer | With an infusion pump; never mix with other drugs; never aspirate; avoid massaging site | Same time every day; PO | Subcutaneous twice daily |
| Avoid | Salicylates and other anticoagulants, e.g., antacids, corticosteroids, penicillin, phenytoin | Same as heparin | Warfarin, platelet aggregation inhibitors (e.g., ASA, NSAIDs, dextran) |
| Antidote | Protamine sulfate | Vitamin K | Protamine sulfate |