Blood Thinners Overview by Nurse Mike

Introduction

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Blood Thinners Overview

Types of Blood Thinners

• Antiplatelets (e.g., Aspirin, Clopidogrel)
  • Compared to a water gun (small)
• Anticoagulants (e.g., Heparin, Warfarin)
  • Compared to a bazooka (medium)
• Thrombolytics (e.g., TPA, Alteplase)
  • Compared to an atomic bomb (large, high bleed risk)

Antiplatelets

Mechanism of Action

• Decrease platelet aggregation
• Prevent clots from forming
• Think: Aspirin (AC for anti-clot) and Clopidogrel (Plavix)

Indications

• Clot prophylaxis and prevention
• Used for MI, CVA, ACS, TIA, PAD, post-stent or bypass
• Important key term: Post-PCI (e.g., post-cath lab)

Key Points Before Administration

• Assess hemoglobin levels:
  • Less than 7 = high bleed risk
• Assess platelet levels:
  • Normal: 150-400
  • Less than 150 = iffy, notify HCP
  • Less than 50 = risky, hold drug, question prescription, notify HCP
  • Condition: Thrombocytopenia (high bleed risk)

Common Exam Questions

• Scenario with platelet count around 75,000 or less than 50,000
  • Priority: Hold the drug, question prescription, notify HCP
• Don't confuse antiplatelets with anticoagulants (focus on platelets, not INR/PTT)

Aspirin Specifics

• Aspirin Contraindications:
  • Condition: Hypoprothrombinemia (low clotting factors)
  • Action: Hold aspirin
• Aspirin Toxicity:
  • Initial treatment: Activated charcoal (blocks absorption in small intestine)
  • Key signs: Tinnitus (ringing ears), hyperventilation
    • Notify HCP
  • Scenarios:
    • Kaplan: Hyperventilation on aspirin = possible poisoning
    • ATI: Long-term aspirin use, assess for tinnitus
  • Non-signs of toxicity: Tachycardia, hypotension (indicate bleed, not toxicity)

Glycoprotein (GP) Receptor Inhibitors (e.g., Abciximab)

• Purpose: Prevention of platelet aggregation (after cardiac procedures like heart cath/coronary stent)
• Adverse Effects: Severe thrombocytopenia, bleeding
• Nursing Care:
  • Assessment of hemoglobin and platelets
  • Same risk levels: Hemoglobin < 7, Platelets < 150 = iffy, < 50 = risky
  • Question prescriptions/orders with low platelet counts
  • Assess for bleeding