Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT)

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Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT)

Definition/Etiology:

N/A

Pathophysiology:

Medication-induced coagulopathies
- Coumadin
- Platelet inhibitors
- Heparin

Noticing: Assessment & Recognizing Cues:

Bleeding
- Bruising
- Petechiae
- Hematoma

Interpreting: Analyzing & Planning:

Complete Blood Count
- Red Blood Cells
- Hemoglobin
- Hematocrit
- Platelets
Coagulation panel
- PT/INR
- PTT
- Anti Xa level
Rule of “10”
- 10 letters= coumadinpt
- 10 letters=heparinptt

Responding: Patient Interventions & Taking Action:

Platelet inhibitors= stop; platelet infusion
Coumadin= vitamin K
Heparin = protamine sulfate
HIT= Direct thrombin inhibitor

Reflecting: Evaluating Patient Outcomes:

Bleeding minimized/stopped
Dose/type of medication adjusted
Education: s/s for bleeding

Linchpins (Key Points):

Rule of 10s
Coumadin= PT/INR; Vitamin K
Heparin= PTT; protamine sulfate
HIT=direct thrombin inhibitor
Antiplatelet= Plt; stop

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Transcript

References

Baroletti, S. A. & Gladhaber, S. Z. (2006). Heparin-induced thrombocytopenia. Circulation, 114, e355-e356. doi: 10.1161/CIRCULATIONAHA.106.632653.

Patriquin, C. & Crowther, M. (2011). Treatment of warfarin-association coagulopathy with vitamin K. Expert Review of Hematology, 4(60), 657-667. doi: 10.1586/ehm.11.59.

Kamath, P. S. (2022). Management of antiplatelet agents in patients undergoing endoscopic procedures. https://www.uptodate.com/contents/management-of-antiplatelet-agents-in-patients-undergoing-endoscopic-procedures.

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