Anticoagulant and Antiplatelet Medication Side Effect Essay

495L-B week 1
1 Journal
1 Discussion
Complete your Week 2 required discussion prompt.
• Discuss two areas of difficulty you encountered or two new nursing interventions you learned this week at your clinical site. You may also choose to share one of each. Please remember to respond to two of your peers. Anticoagulant and Antiplatelet Medication Side Effect Essay

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Complete your Week 2 required discussion prompt.
• Discuss two areas of difficulty you encountered or two new nursing interventions you learned this week at your clinical site. You may also choose to share one of each.
Journal
Topic for the Journal: Anticoagulant and Antiplatelet medication side effect risk on older population.
Example: Incorrect doses, falls, medication and food interactions

• 1 What are your upcoming week’s specific learning goals and objectives?
• 2 What is your upcoming week’s detailed schedule at your community practice experience placement? Two days, 4 hours each day Anticoagulant and Antiplatelet Medication Side Effect Essay
• 3 Were there any placement items/issues that occurred this week that you feel your instructor should be aware of that are private in nature and are more appropriately shared here than in the discussion board with your classmates?
• 4 Give a brief description of an objective you worked on this week. Make sure to cite at least one reference showing how your objective relates to the public health knowledge you’ve studied during this course or the public health course. You may choose to reference your e-text, journal articles, or videos you’ve studied during these courses or you may find an outside reference on your own to further enhance your public health knowledge and practices.
Remember, your journal entries are an important aspect of clinical learning as they serve to help you reflect upon and get the most out of your community practice experience. Therefore, your journal entry should include the who, what, where, and when of your community practice experience. Remember, this should simulate a dialogue that would normally take place face-to-face with your community practice experience instructor. Anticoagulant and Antiplatelet Medication Side Effect Essay

At least 700,000 people suffer from stroke each year in America. Stroke is caused by blockage of blood within its system. The blockage results to lack of blood flow in some areas of the brain. The injury of these parts of the brain is referred to as ischemia. In this case, one or more areas within the brain may be damaged. The person affected can lose various abilities depending on the part of the brain that has been injured. These injuries can come in form of a person losing the ability to speak, walk or move one side of the body. The damages may be temporal or permanent, and the functions affected may be lost completely or partially (Berry, 2010). The result is dependent on the severity of the brain damage, the time the first treatment is administered, among other factors. Anticoagulant and Antiplatelet Medication Side Effect Essay

Recent research confirms that people have assumed sedentary lifestyles (Caplan, 2006). In addition to the high cholesterol intake, majority of the adults are at high risk of health complications such as VTE. VTE is among the four main causes of death among the Americans. A third of the VTE patients succumb within thirty days (Hutton, 2005). Among the leading alert medications is the anticoagulant. Hence, there is need for patients to be protected against the effects of anticoagulation therapy. The realization has led to the introduction of basics of medication to the nurses. These basics form the fundamental rights which include: patient, medication, route, dose and time. If all nurses can adhere to these basics of education, then few errors can occur. Anticoagulant and Antiplatelet Medication Side Effect Essay

Statistics also show that stroke is among the leading causes of lifelong injuries and death (Hutton & Caplan, 2003). Early management of disease together with preventive measures has bore fruit of reducing further brain damage. Treatment is based on the type: the ischemic and the hemorrhagic stroke. Underlying medical problems are viewed as a cause of prolonged treatment of the disease. Platelets are blood components that exist in form of tiny cells. They only clump during bleeding or in abnormal conditions, forming the clotting of blood. Anticoagulants are mostly referred as blood thinners. This is because they act by reducing blood clots within the arteries. Due to their nature, anticoagulants are rarely administered to ischemic patients. Anticoagulant and Antiplatelet Medication Side Effect Essay

TREATMENT OF EARLY STROKE
For ischemic patients, treatment involves restoration of blood flow into the brain as quickly as possible. Aspirins, anticoagulants and alteplase are used as the first treatment of stroke (McBane, 2010). Thrombotic therapy (alteplase) involves the use of tissue plasmigen activator (tPA). This treats by dissolving clots which block the flow of blood within the brain arteries. Its benefit lies within the fast coordination of the hospital to offer emergency services with the neurologist available. Previous statistics prove that this medicine has much more benefits than side effects (Davis, 2005). Out of fifteen patients who were administrated with thrombotic therapy, one of them developed excessive bleeding. The statistics further reveals that the result can be fatal. It leads to personal choice of drug consumption. Aspirin is administered when thrombotic drugs cannot be given. It is an early treatment drug against acute ischemic stroke. Anticoagulant and Antiplatelet Medication Side Effect Essay

ANTICOAGULANT THERAPY
This works by interfering with the process of clotting. Frequent indications for the use comprise: treatment of disseminated intravascular syndrome, prophylaxis and management of pulmonary embolism and venous thrombosis (Jennings, 2008). Prevention of thrombo-embolic complications related to vascular and cardiac surgery. Coagulation examination must be carried out before administration of an anticoagulant. It allows any abnormal results to be taken to the physician first. The normal ranges are: Anticoagulant and Antiplatelet Medication Side Effect Essay

Platelets 150 – 400 x 109/ L
APPT 30-40 sec.
PTT 60-70 sec.
PT 11 – 13 sec.
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PREVENTION OF ISCHEMIC STROKE
For patients with history of ischemic, doctors should prescribe drugs that can prevent recurrence of the stroke. The treatment includes anti-platelet and anticoagulant medications. Surgical procedures are at times considered when it is necessary to open up blockages (Skidmore-Roth, 2007). To prevent recurrence of ischemic stroke, anti-platelet therapy is administered. One of these anti-platelet therapies given after an occurrence of a stroke to prevent its recurrence is Dipyridamole. It is given in form of release. The patient takes it two times daily. This drug is mostly combined with aspirin. Common side effects of this drug are stomach upsets diarrhea and headaches. The patient on medication is expected to show improvement after the first one week. Anticoagulant and Antiplatelet Medication Side Effect Essay

Clopidogrel is an antiplatelet drug also used after a patient has had a stroke. It is useful in preventing any recurrence. Previous studies have proved that this drug is much better than aspirin. Hence, it is highly recommended as an alternative drug to aspirin. In can, however, not be used in combination with aspirin. This is because it increases the chance of brain bleeding. The side effects of this drug are rashes, diarrhea, gastrointestinal bleeding and stomach upset. Aspirin, as an anticoagulant, is effective in higher doses than in smaller doses (Ansell, 2007). It is also very cheap in price compared to dipyridamole and clopidogrel. Anticoagulant and Antiplatelet Medication Side Effect Essay

Anticoagulant therapy is used in prevention of stroke. The therapy comprises the warfarin and dabigatran. Warfarin is a pill that is taken orally. It is used in patients who have a high probability of forming clots. Such patients must be monitored closely to prevent further bleeding and to reduce any enlargement of blood clots. Dabigatran is used to thin blood, and it is mainly used by patients with atrial fibrillation of the heart. It is better than Warfarin as it requires little supervision. It is, however, more expensive than Warfarin. Anticoagulant and Antiplatelet Medication Side Effect Essay

Revascularization refers to the process of restoring flow of blood in a part of the brain (Sullivan, 2006). For the stroke patients, it refers to the surgical procedure of opening the carotid artery. This prevents occurrences of stroke as it increases blood in the brain. In order to know the extent of the blockage, the patient is advised to go for an ultrasound imaging test or the conventional arteriogram. Carotid endarterectomy is a procedure done to open up blocked tubes. Its risks are equal to its successes. Risks are inclusive of stroke, bleeding, brain injury or death. Another alternative is the placement of stent in the tube at the neck. This carries a higher risk than carotid endarterectomy. Anticoagulant and Antiplatelet Medication Side Effect Essay

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COMPLICATIONS
Several patients face other problems after they have had stroke. These complications are viewed as risky. This is because majority of deaths caused by stroke are mainly due to complications. Immediately after stroke, the care givers and the family members can reduce the risk of some of these diseases. Major complications comprise heart failure, blood clots, pneumonia, and difficulty in taking meals, bed sores, falls, urinary tract infections and bleeding in the digestive system (Jennings, 2008). Most of the patients of stroke are affected by blood clots. These clots always move along the blood vessels. They can cause blockages anywhere in the body. This leads to difficulty in walking which may further lead to paralysis. Such patients are mostly treated with heparin. Anticoagulant and Antiplatelet Medication Side Effect Essay
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NURSING IMPLICATIONS
After stroke, it can be difficult to know what may happen next. The medical profession should prepare the care givers and the families about the long term risk and death. It is, however, indispensable to watch and wait. Anticoagulants are used when the patient is bleeding or during menstruation. When brushing their teeth, the patients should use toothbrushes with soft bristles. In addition, they are to use electric razor. These are measures put to reduce chances of bleeding. For negative effects of this management to be reduced, patients must be educated to be able to protect themselves from any injury or bleeding. In case they see any bleeding signs in the gums, urine or stool, they should report it immediately to the physician. Patients should also avoid using aspirin, NSAID or steroids since they highly react to the anticoagulants. Anticoagulant and Antiplatelet Medication Side Effect Essay

There are times when the patients must use anticoagulants. However, caution should be exercised to avoid further bleeding. Aspirin is mainly used to prevent further production of thromboxane A2. The effect of antiplatelet of this anticoagulant lasts for 7 days. Only patients with a lower risk of stroke can use this drug. Gastrointestinal side effects caused by the use of aspirin can be relieved by reducing the dose given. Warfarin can also be used alongside heparin. It is because warfarin takes longer to react. The drug is, however, necessary because it is used to prevent recurrence of thrombi. A daily dose of about 10 mg is administered until the normal ratio is achieved. Others incorporate the use of vitamin K in to the management. Equally, the doses can be adjusted depending on the age and severity of the problem. Factors such as drug interactions, compliance of the patient, diet and metabolism of the drug affect the administration of the drug. Anticoagulant and Antiplatelet Medication Side Effect Essay

Heparin is also employed to reduce the formation of blood clots. It acts at multiple sites to stop the clots from enlarging. It also prevents exchange of fibrinogen to fibrin. Very few patients can use this drug and hence, its dosage is also very specific. Plavix is another antiplatelet agent. It works by inhibiting the first two phases of platelet aggregation (Jennings, 2008). It inhibits the aggregation that is stimulated by other ADP. Plavix is administered to reduce the threat in critically ill patients. To reduce the gastric side effects, this drug should be administered with food. The drug is mostly prescribed to patients as it does not require consistent monitoring of the blood. Thus, it best suits patients on long term therapy. When administering heparin, complete occult blood and blood count should be studied. Lab tests have to be monitored strictly. To avoid bolus infusions when administering heparin intravenously, the nurse should avoid piggybacks. She should also create a separate line in addition. Ticlid is another drug that is used to inhibit the threat of stroke in patients. To reduce further bleeding in patients, platelet transfusions should be administered. There is need for care givers to stop the treatment for around five days for patients receiving anticoagulant therapy. This is to prevent early death rate (Huttona & Caplan, 2003). Anticoagulant and Antiplatelet Medication Side Effect Essay

Caution should be exercised as the dose given may be higher than that of preventive measures. Patients are advised to often move their limbs to prevent any clotting of the blood from taking place. This may require the help of a therapist. A stroke patient may develop dysphagia. This may lead to inhalation of saliva or food into the lungs. Caregivers need to exercise great care as this can lead to death. To determine whether a patient is at risk of dysphagia, water should be given to see if they have the ability to swallow. If this test turns negative then no food should be given orally. Instead, nutrition and medication should be given through the vein. Training programs and exercises can be introduced for the patients to swallow without the help of the nerves and the muscles. In addition, additives can be added to the food to make the liquids thick. The use of a catheter is employed to patients who have the difficulty of passing urine. Care givers should eliminate the risk of the patient contracting a urinary infection. This can be implemented by using it only when necessary, removing the catheter as soon as possible and changing the catheter. Anticoagulant and Antiplatelet Medication Side Effect Essay

At times a person loses the ability of recovering from stroke. This increases the chance of long term disability. The main cause of this problem is malnourishment before and after stroke. There should never be a reduction of the nutritional quantity taken in. This should be elevated prior to the patient being discharged. Feeding tube should be placed through the nose to the stomach to ensure the wellness of the patient. Patients who have had severe stroke may most likely have GI bleeding; thus, medication ought to be administered to lower the amount of gastric acid being produced. Heart problems such as irregular heart rhythm are also a common occurrence after stroke. More than 70% of the patients develop this problem later on. Before administration of drugs, other causes of the problem need to be ruled out. Tests carried out to ascertain the cause includes ECG and electrocardiogram (ECG). Bed sores are problems that occur because the patient could have lied on one area for so long. The skin injury may take different forms from mild to deep ulcers. This increases the risk of the patient to other infections. Care givers should help the patient turn every two hours. Patients should be placed at different angles to prevent them from exerting pressure on their hip bone. Pillows can be used to elevate the ankles and the knees to reduce pressure at those areas. However, the head of the bed should not be elevated frequently. Anticoagulant and Antiplatelet Medication Side Effect Essay

In addition to this, exercises need to be carried out. Exercises are to strengthen the muscles and enable the patient walk again. As the patient is exercising, the risk of falling should be totally eliminated. This is because fall is categorized among the risks to life threatening complications. A care giver should be assigned to every patient to eliminate such risks. If the patient has been discharged, home hazards should be removed. Loose rugs can be kept away from the patient’s path and lighting system can be improved for the sake of the patient. The care giver and family members should ensure that the patient is well clothed to avoid any loose cloths that may cause falls. Anticoagulant and Antiplatelet Medication Side Effect Essay

CONCLUSION
More than 450,000 American citizens are suffering from stroke related illnesses (Aplan 2006). This is because of the kind of sedentary lives people have opted for. Thus, there is need for people to take physical exercises seriously. Good nutrition, rest and removal of stress all play a very big part in the natural prevention of the disease. To prevent recurrence of stroke, aspirin and warfarin anticoagulants should be administered (Hutton, 2005). They are used in the treatment and prevention of clotting disorders. These drugs have side effects and vary in dosage from person to person, raising the issue of their nursing implications. Such implications include monitoring of laboratory results and administration of therapy. This should be exercised before and after drug administration. Finally, emerging issues like dissolution of clots require the introduction of thrombolytics. Anticoagulant and Antiplatelet Medication Side Effect Essay

Anticoagulants and antiplatelet agents are drugs used to reduce the
risk of blood clots or prevent existing clots from getting larger in the
body. These are also known as blood thinners. These medicines help to
prevent the clots the in blood vessels or heart [1]. When get the cut or
scarp blood clots are commonly good. But, when blood clots form in
the blood vessels, arteries or heart, these are very dangerous because
they can block the blood circulation. Ultimately they stop the flow of
blood. These blocks can cause the heart attack and also block the blood
in brain, it causing stroke. Certain types of heart valves are prone to
forming blood clots. Such clots can shoot out to the lungs or the brain. Anticoagulant and Antiplatelet Medication Side Effect Essay
Which is called preventive or prophylactic treatment. Anticoagulant
and antiplatelet drugs work by preventing the platelets from following
to one another and clotting proteins from binding together [2]. Oral
antiplatelet agents have been reported to reduce vascular deaths by
15% and serious cardiovascular events by 20% in high risk persons [3].
The effect of antiplatelet therapy in diabetic neuropathy should be
examined in long-term clinical trials that may potentially unfold its
benefits over time [4].
Types of Anticoagulant and Antiplatelet Drugs
1. There are two types of anticoagulant drugs commonly used
Heparin
Coumadin
1. Commonly used Antiplatelet Drugs drugs are
Aspirin: Acetylsalicylic acid or Aspirin (ASA) is a over pain reliever
that also has anti platelet properties. Aspirin is a “classic” antiplatelet Anticoagulant and Antiplatelet Medication Side Effect Essay
agent frequently used in primary and secondary prevention of
atherothrombotic events not only in patients with ACS. Large
numbers of patients continue to experience these events despite
aspirin therapy [5]
Clopidogrel: Clopidogrel (clopidogrel bisulfate, Plavix) is an antiplatelet drug that is effective is reduce the strokes and heart attacks and
is often prescribed to patients who receive a coronary stent.
Clopidogrel is a pro-drug that requires hepatic biotransformation [6].
Rotational atherectomy allows plaque remodeling in severely calcified
lesions and, prior to the adoption of clopidogrel as standard therapy
[7].
Prasugrel: Prasugrel is also related to Clopidogrel, it is a novel
prodrug from the same family as clopidogrel, with more efficient
platelet inhibition.
Dipyridmalole: Dipyridmalole is commonly used as anti-platelet or
anticoagulant drugs, Acetylsalicylic acid or Aspirin. It can also be
given by injection during tests on the heart to the patients.
Glycoprotein IIb/IIIa antagonists: Abciximab was the original GP
IIb/IIIa antagonist, thase are a monoclonal antibody with a much
continued duration compared to newer agents, eptifibatide is a nonpeptide antagonist. These drugs prevent the final common pathway of
platelet formation where fibrinogen binds to GP IIb/IIIa receptor [8] Anticoagulant and Antiplatelet Medication Side Effect Essay
Thienopyridines: The antiplatelet activities of the indirectly acting
thienopyridines are delayed as a consequence of the need for
metabolism of the prodrug. Furthermore, there are considerable
interindividual discrepancies in the degree of metabolism of the
prodrug leading to unpredictability in platelet inhibition [9].
How does it work?
Antiplatelet drugs are intended to prevent and/or reverse platelet
aggregation in arterial thrombosis, most prominently in myocardial
infarction and ischaemic stroke.
Anti-platelets, such as Acetylsalicylic acid or Aspirin (ASA), act on
platelets in the blood, assemble it less sticky so that the platelets are
less possible to produce clots that block arteries and may cause heart
attacks or strokes [10]. Dual antiplatelet therapy (DAPT) consisting of
aspirin and a thienopyridine was used to mitigate any negative
consequences including stent thrombosis and recurrent cardiovascular Anticoagulant and Antiplatelet Medication Side Effect Essay
events [11].
Difference
Anticoagulates such as heparin or warfarin, those are most effective
for involving venous clots. When an excessive amount of fibrin venous
clots are formed, Fibrin protein that causes blood clotting, it develops
in blood. An anticoagulant use to dissolves venous clots by disrupting
the development of fibrin protein, it is the best drug choice for
conditions such as deep-vein thrombosis or pulmonary embolism. In
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contrast, Antiplatelets are not generally suitable for using to treat the
venous clots and are these most effective for preventing artery clots.
When damage occured Platelets are join together in the blood, such as
cuts, bruises or internal injuries occurs. Sometimes Platelets also
combine too rapidly when the arteries are inflamed, causing a block in
an artery wall. Antiplatelet drugs such as aspirin, prevent the platelets
from forming and are usually these are prescribed when clots are
artery-based. Anticoagulant and Antiplatelet Medication Side Effect Essay

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Antiplatelets target the production of thromboxane, these are
secreted by platelets that causes blood clotting, Anticoagulants attack
only clotting factors. These are any other agents that contribute to
blood clots. Anticoagulants are generally stronger and more aggressive
than Antiplatelets [12].
Advantages
• The advantages and limitations of various antiplatelet agents that
have been approved by the US Food and Drug Administration
(FDA) or under development [13].
• The advantages are that they no longer require blood tests to
monitor their effectiveness
• The greatest advantage of these drugs is that they prevent blood
clots and also the serious complications. Aspirin specially is a
lifesaver. Reduce the risk of a transient ischemic attack (TIA),
stroke, and heart attack.
• a short course of anticoagulation is good enough. Typically, the
longer a person is on blood thinners, the less their chance of
having another clot, but this must be weighed against the increase
chance for bleeding. After a second clot, though, sometimes
lifelong is better.
• Anticoagulants carry a risk of bleeding. Usually there is a very
good reason for taking anticoagulants in pregnancy.
• Anticoagulant medication is not used to treat rheumatoid arthritis.
Disadvantages Anticoagulant and Antiplatelet Medication Side Effect Essay
• Typically the drugs will cause harm issues, headaches, dizziness,
pain, discomfort. gastritis, ulceration, and bleeding [14,15]
• ASA can irritate your stomach and in some cases can cause
bleeding. ASA should never be given to children because it has
been linked to Reye’s syndrome, a rare brain and liver disorder.
• Coumadin can cause the risk for bleeding, pregnant, or
breastfeeding. Because anti-platelets interfere with the clotting
action of the blood, they can increase the risk of uncontrolled
bleeding. Anti-platelets should not be taken by individuals who
have an ulcer or history of bleeding problems. Abnormal bruising
may be a symptom of a bleeding problem. Anti-platelet
medications can irritate the stomach, promote the development of
ulcers, and increase water and salt retention.
• It is high cost & safety concerns
• Enteric coated or buffered tablets have not been shown to reduce
the likelihood of major gastrointestinal adverse effects.
• Increased risk of bleeding in surgical procedures due to impaired
primary hemostasis. Anticoagulant and Antiplatelet Medication Side Effect Essay
• Decrease the Platelet’s life span
Conclusion
The present observations on Anticoagulants and antiplatelet agents
are partially useful and cause so many side effects in the body. So the
people will change the everyday lifestyle. Eating a healthy diet that’s
lower in fat, particularly saturated and trans fats, being smoke free,
limiting alcohol use, being physically active and reducing stress also
are vital in lowering the chance of heart condition. Visit your healthcare practician concerning however you’ll be able to come through
these life style changes. Hence these should be used under proper
guidance of the physician. This will reduce the side effects of these
birth control drugs. The routine transfusion of platelets in TBI patients
on preinjury antiplatelet therapy Anticoagulant and Antiplatelet Medication Side Effect Essay