| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Enoxaparin (Lovenox)—Subcu 30–40 mg twice daily, 7–10 days or 1 mg/kg q12h | Deep vein thrombosis; prophylaxis before knee and abdominal surgery | Potentiates inhibitory effect of antithrombin | Bleeding, anemia, thrombocytopenia |
| NURSING IMPLICATIONS: Observe injection sites for hematomas, ecchymosis, or inflammation; ice cube massage at site prior to injection may lessen bruising |
| Heparin—initial dose: IV bolus of 5,000 units, followed by infusion of 20,000–40,000 units over 24 hr | Acute thromboembolic emergencies | Prevents thrombin formation | Hematuria, bleeding gums, ecchymosis |
| NURSING IMPLICATIONS: Observe clotting times—should be 20–30 min; antagonist is protamine sulfate |
| Warfarin sodium (Coumadin)—initial dose: PO 10–15 mg; maintenance dose: PO 2–10 mg daily | Venous thrombosis; atrial fibrillation with embolization; pulmonary emboli; myocardial infarction | Depresses liver synthesis of prothrombin and factors VII, IX, and X | Minor or major hemorrhage; alopecia; fever; nausea, diarrhea; dermatitis |
NURSING IMPLICATIONS: Drug effects last 3–4 days; antagonist is vitamin K;  avoid foods high in vitamin K; no aspirin |