- Body system
- Blood and clotting
- Name stem
- -parin, -xaban, -gatran
- Drug cards
- 4 in this guide
Drugs in this class
Other examples: Rivaroxaban, Dabigatran, Edoxaban, Dalteparin, Fondaparinux, Argatroban, Bivalirudin.
How anticoagulants work
Heparin works through antithrombin on thrombin and factor Xa; low-molecular-weight heparins mainly on factor Xa; warfarin blocks vitamin K-dependent clotting factors; direct oral anticoagulants directly inhibit factor Xa (-xaban) or thrombin (dabigatran).
Uses
- DVT and pulmonary embolism
- Stroke prevention in atrial fibrillation
- Mechanical heart valves (warfarin)
- Acute coronary syndrome
- DVT prevention after surgery
Adverse effects
- Bleeding
- Bruising and hematomas
- Heparin-induced thrombocytopenia (heparins)
- Spinal or epidural hematoma with neuraxial anesthesia
Nursing considerations
- Know the monitoring test: aPTT or anti-Xa for IV heparin, INR for warfarin (usual goal 2 to 3), no routine coagulation test for direct oral anticoagulants.
- Monitor hemoglobin, platelets and signs of bleeding; use bleeding precautions.
- These are high-alert medications: double-check doses and concentrations.
Patient teaching
- Use a soft toothbrush and electric razor.
- Report black stools, blood in urine, nosebleeds and severe headache.
- Avoid NSAIDs and aspirin unless prescribed. On warfarin, keep vitamin K intake consistent.
Anticoagulants NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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Which lab value is used to monitor warfarin therapy?
Show answer
Answer C: INR Warfarin is monitored with the PT/INR; the usual target is 2 to 3.
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A patient on a heparin infusion has a platelet count that dropped by more than 50% from baseline. What does the nurse suspect?
Show answer
Answer D: Heparin-induced thrombocytopenia A large platelet drop, typically 5 to 10 days after starting heparin, suggests heparin-induced thrombocytopenia, which paradoxically causes clotting.
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Which antidote should be available for a patient receiving a heparin infusion?
Show answer
Answer C: Protamine sulfate Protamine sulfate neutralizes heparin. Vitamin K reverses warfarin.
Frequently asked questions
What are anticoagulants?
Anticoagulants prevent clots from forming or growing; they do not dissolve existing clots. Know each drug's lab test and reversal agent: heparin, aPTT and protamine; warfarin, INR and vitamin K.
How do anticoagulants work?
Heparin works through antithrombin on thrombin and factor Xa; low-molecular-weight heparins mainly on factor Xa; warfarin blocks vitamin K-dependent clotting factors; direct oral anticoagulants directly inhibit factor Xa (-xaban) or thrombin (dabigatran).
What are examples of anticoagulants?
Heparin, Enoxaparin, Warfarin, Apixaban, Rivaroxaban, Dabigatran, Edoxaban and Dalteparin.
What are the nursing considerations for anticoagulants?
Know the monitoring test: aPTT or anti-Xa for IV heparin, INR for warfarin (usual goal 2 to 3), no routine coagulation test for direct oral anticoagulants. Monitor hemoglobin, platelets and signs of bleeding; use bleeding precautions.