hey there it's christine from nurse in the making and today i'm going to talk about anticoagulants specifically heparin and warfarin if you're following along with your pharmacology flash cards i'm in a cardiovascular section on the heparin and the warfarin card before we dive into the core differences between these two medications let's talk about what anticoagulants do and what they don't do what they do is they prevent new clots from forming and they prevent current clots from getting bigger what anticoagulants don't do is thin the blood you'll hear heparin and warfarin called blood thinners but don't let that confuse you they don't thin the blood or dissolve clot they only prevent new clots or prevent current clots from getting bigger let's talk about some therapeutic uses for these medications like i said before they prevent or treat blood clots in those with dvts deep vein thrombosis pes which are pulmonary embolisms and afib which is a dysrhythmia that causes blood to accumulate in the heart's chambers causing blood clots it also helps prevent clots such as dvts and pes post-operatively meaning clients who just got out of really long surgeries are at increased risk for blood clots all right let's dive into the medication names the brand name for warfarin is cumidin heparin is a little bit more difficult because it's available as heparin sodium and something else called low molecular weight heparin you'll see it written as lmwh also called fractionated heparins examples of a low molecular weight heparin is a noxiprine brand name lovenox low molecular weight heparins are easy to recognize because of their suffixes the suffix is paren like anoxic and here's a study tip for pharmacology learn the suffixes for each medication class rather than memorizing each medication individually it's almost impossible to remember every single medication in your textbook so i like to use this thing called save by the suffixes method for learning medication the difference between heparin and low molecular weight heparins is that low molecular weight heparins produce a more stable response and they have a lower chance of bleeding than heparin sodium all right let's dive into the key differences between these two medications heparin can be given intravenously or subcutaneously but heparin can't be given orally because heparin is inactivated by gastric acids in the stomach warfarin can be given orally or intravenously but it's most commonly given orally now for the onset of these medications the onsets are very different heparin's onset is really rapid it can take minutes to take effect this is why it's great for a short-term therapy you can remember this by the memory trick heparin happens fast the onset of warfarin is much different the onset is very slow it can take hours to take effect and even days to reach maximum therapeutic levels which is why it's great for a long-term therapy you can remember this by the memory trick warfarin you have to wait a common question that's asked is can you give heparin and warfarin together the answer is yes both medications will be given for several days until warfarin reaches therapeutic levels heparin works immediately which allows time for warfarin to take effect okay let's talk about the effects of these medications during pregnancy heparin is safe to give during pregnancy because it does not cross the placenta or into the breast milk warfarin is not safe during pregnancy because it crosses the placenta and is teratogenic meaning it causes harm to the developing fetus a memory trick for this is warfarin think wait don't give that to a pregnant person now for monitoring of these medications so many students get confused with this topic but i'm gonna break it down into simple terms heparin is measured with something called aptt and warfarin is measured with something called inr you can remember heparin is measured with aptt because heparin has a p in it and warfarin doesn't apt stands for activated partial thromboplastin time and inr stands for international normalized ratio these are coagulation tests they are blood tests to measure how fast or slow the blood is clotting and measured in seconds here are some must known numbers when remembering aptt and inr the normal range for aptt when taking heparin is 47 to 70 seconds the normal range for iron r while taking warfarin is two to three seconds what does it mean when these values are out of range if aptt or inr is too high there is an increased chance for bleeding the memory trick is numbers are too high the patient will die meaning from bleeding out but if these numbers are too low the clots will grow so this is why we want to make sure these lab values are in a therapeutic range because if they exert their effect too much the patient can bleed out and if they aren't working enough the clots will grow each medication has an antidote you would give this antidote if aptt or inr exceeds the therapeutic level or if there is evidence of bleeding the antidote for heparin is protamine sulfate you can remember this by the memory trick you will need help from a pro to stop bleeding out the antidote for warfarin is vitamin k you can remember this by the memory trick during war vitamin k kills warfarin let's talk about some patient teaching when a patient is on warfarin you want to educate your patient to be consistent with their vitamin k intake vitamin k foods include green leafy vegetables like kale and spinach and liver think about this i just said the antidote for warfarin was vitamin k so if the patient consumes too much vitamin k it's like they're consuming the antidote and it will make the medication ineffective so tell your patients to be consistent with their vitamin k intake don't drastically increase or decrease their intake of vitamin k the nclex word here is be consistent with their vitamin k intake some patient education for heparin is about administration when educating your patient about heparin you want to educate them to administer the medication subcutaneously in the belly two inches away from the umbilicus meaning the belly button at a 90 degree angle do not massage the site after injection and educate your patient that after administration it's common to have bruising irritation and pain after administration a complication of both warfarin and heparin is that they both cause increased risk for bleeding so we want to teach our patients about bleeding precautions this includes avoiding nsaids aspirin avoiding antibiotics and alcohol even alcohol-based mouthwash you want to educate your patient to avoid you want to educate them to brush their teeth with a soft bristled toothbrush you want them to avoid contact sports educate them to remove throw rugs around the house because these could increase the risk for falls they want to use an electric razor and wear a medic alert device okay let's review the key differences heparin is given iv or sub-q it can't be given po warfarin is given most commonly po heparin is safe to give during pregnancy while warfarin is territogenic and should be avoided during pregnancy heparin's onset is rapid and warfarin's onset is slow heparin is monitored with aptt and warfarin is monitored with inr the antidote for heparin is protamine sulfate and the antidote for warfarin is vitamin k and remember they both increase the risk for bleeding that's all for heparin vs warfarin if you want more pharmacology information like this you can find it in the pharmacology flashcards happy studying future nurses [Music] you