-Process of forming a solid slate of blood, w/ a purpose of maintaining the stability of the cardiovascular system.

-Delicate Balance

-Tendency to clot or form a solid state.

Blood Coagulation:

STEP 1

-1st reaction to a blood vessel injury. If injury is small, it can be sealed off and healed. 

-Important in staunching hemorrhage & acute blood loss

-Constriction of a blood vessel which reduces blood flow.

Blood Coagulation:

STEP 2

-Injury to blood vessel exposes blood to the collagen which causes platelets in the circulating blood to "stick" to the site of injury (collagen) & release a chemical (ADP) that attracts other platelets to the site. 

-Clumping together of platelets. Creates platelet plug @ the site of vessel injury.

Platelet Aggregation

**Vasconstriction & platelet aggregation work together to seal off the injury & keep the cardiovascular system intact.

Blood Coagulation:

STEP 3

-Activated thrombin breaks down fibrinogen to form insoluble fibrin threads, which form a clot inside the blood vessel. The clot, called a thrombus, acts to plug the injury & seal the system.

Blood Coagulation:

STEP 4

-Cause the blood that has leaked out of the vascular system & into the surrounding tissues to clot.

-Injured cells release Thromboplastin, which activates clotting factors in the blood & starts the clotting cascade to form a clot on the outside of the blood vessel.

-Protein dissolving substance that breaks down the fibrin framework of blood clots & opens up vessels.

-Can be stimulated thru out the body when intrinsic pathway is started

-Interferes w/ the normal coagulation process.

-Interferes w/ the clotting cascade (Plan C & D: Intrinsic & extrinsic pathway)

-Affects plan B

-Affects the formation of the platlet plug (Platelet Aggregation)

Thrombolytic Drugs

Commonly called "blood thinner"

-But not really blood thinner-They dont thin the blood

*Best way to thin blood is to use NS

Anti coags

Anti platelet

-Decrease the formation of the platelet drug

-Keeps the platelets from sticking together.(Plan B Step2)

Antiplatelets

Prototype:____

Antiplatelets

Prototype: Aspirin

Indications (7):

1. Prevent strokes
2. MI's
3. Occluded vessels
4. Intermittent claudification
5. Analgesic
6. Anti-inflammatory
7. Anti-pyretic

Antiplatelets

Prototype: Aspirin

Adverse Reactions (5):

1. Bleeding (esp. GI & dental)
2. Tinnitus
3. Asprin Toxicitiy
4. Heart burn
5. Rash

Antiplatelets

Prototype: Aspirin

Nursing Implications (5):

1. Watch for S&S of adverse effects
2. Bleeding precautions
3. Monitor INR
4. Promote enteric coating
5. Stool check (Blood)

Anti-Coags

Prototype: ____

Anti-Coags

Prototype: Heparin

Common name: ____

Anti-Coags

Prototype: Heparin

Indications

1. Prevention of PE, DVT, cardiac embolus (AFib: Risk)
2. MI
3. IV & Dialysis lines.
4. Breaks clots down

Anti-Coags

Prototype: Heparin

Action (2):

1. Prevents conversion of prothrombin to thrombin, thus preventing fibrin from forming (Intrinsic pathway)
2. DOES NOT dissolve the clot!

Anti-Coags

Prototype: Heparin

Adverse Effects:

Anti-Coags

Prototype: Heparin

____: Inhibits clot formation by blocking different clotting factors

-Used because they have less side effects

-Also used to prevent/slow down Ca

-Used for post op surgery pt & pts on long term bed rest

Anti-Coags

Prototype: Heparin

Nursing Implications

1. Monitor for s&s
2. Monitor lab work (PTT)
3. Patent IV lines
4. Will always give IV or sub q
5. be VERY careful dosing this medication
6. When starting- usually give a IV bolus, then start IV

IV Line Care:

 1. D/Cing IV

2. Lab draws (TLSL & Peripheral)

3. ______

Anti-Coags

Prototype: Coumadin (Warfarin)

**Always PO**

Indications (7):

1. Preventing clot formation-maintenance
2. Long term Tx
3. A Fib patients
4. HF
5. Artificial heart valve
6. DVT
7. Post MI/PE

Anti-Coags

Prototype: Coumadin (Warfarin)

Actions (2):

1. Works differently than heparin
2. Prevents production of vitK dependent clotting factor (VitK causes clotting enhancement)

Anti-Coags

Prototype: Coumadin (Warfarin)

Adverse Effects (2):

1. Same as Aspirin only more severe
2. Antidote: Vit K is usually give sub Q or PO

Anti-Coags

Prototype: Coumadin (Warfarin)

Nursing Implications (7):

1. Same as Aspirin
2. Monitor lab work (PT/INR)
3. Teach pt compliance w/ med
4. F/U labs
5. Dietary Restrictions: Foods high in vitK. Watch Herbals!
6. Stool Check
7. Avoid if PG

Anti-Coags

Prototype: Coumadin (Warfarin)

Onset of action:

Anti-Coags

Prototype: Coumadin (Warfarin)

Effect last ___: Educate pt about holding a few days before surgery.

Thrombolytic Agents

Prototype:____

Thrombolytic Agents

Prototype: Strept-Kinase (Streptase)

Indications (5):

1. Used to dissolve clots!
2. Coronary thrombosis
3. PE
4. DVT
5. Strokes

Thrombolytic Agents

Prototype: Strept-Kinase (Streptase)

Actions (2):

1. Thrombolytic agents usually dissolve on existing clot.
2. Activates plasminogen to plasmin-which breaks down the fibrin threads

-Measures the extrinsic pathway activity. Measures how long it takes the blood to clot (Measures Plan B step 4 Intrinsic Pathway)

Normal: 10-13secs

INR

Therepeutic Range: 

-Measures the activity of the Intrinsic pathway (Plan c Step 3). It also measures the time it takes your blood to clot.

-Measures Heparin!

PTT

Normal Time: