Should I give this dose?

Question

I'm a nursing student and i'm stuck on this question we were assigned.

The patient is recieving Heparin drip@100 units/hr IV. The PTT is 80 seconds( normal 22-32) and INR is 0.5. the physcian orders Coumadin 10mg. Should you give this order without questioning the drug or the dose?

The patient is recieving Heparin drip@100 units/hr IV. The PTT is 80 seconds( normal 22-32) and INR is 0.5. the physcian orders Coumadin 10mg. Should you give this order without questioning the drug or the dose?

Also if the patient does not have money to pay for these prescribed anticoagulant medications after discharge what would you do or consider?????????

The patient is recieving Heparin drip@100 units/hr IV. The PTT is 80 seconds( normal 22-32) and INR is 0.5. the physcian orders Coumadin 10mg. Should you give this order without questioning the drug or the dose?

Also if the patient does not have money to pay for these prescribed anticoagulant medications after discharge what would you do or consider?????????

Answer 1

The PTT is higher than normal and the INR is VERY low. PTT is the measure of Heparin and the IRN is a measure of coumadin. I dont think I would give the coumadin because the INR needs to be in a 2-3 range. The heparin drip is fine, but still the PTT is high. But the INR for the coumadin is just to low.

Answer 2

It's ok to give both.

You'll know that heparin is taking it's effect if the PTT value goes up 1 - 2.5 times the normal value. It means that it's action to prevent coagulation is taking place. Therefore PTT of 80 secs means therapeutic level of heparin. Otherwise if the PTT is normal when a client is taking heparin, then it will mean that the drug is not taking it's effect, and the client is still at risk for coagulation problems.

The larger than the usual coumadin dose is also necessary. INR normalizes the different protime values in different laboratories (meaning no matter what the Prothrombin time is, you'll get same INR with same blood sample in any laboratory). Normal is 2-3 but the patient's INR is 0.5. The lower it goes, the more is the risk for coagulation. so we need an increased dose of an anticoagulant. (in this case coumadin), to increase it to at least 2. That's why the physician ordered the 10 mg dose. And besides, coumadin has a longer onset of action.

Check more on the intrinsic, extrinsic, and common clotting pathways. PTT checks the extrinsic pathway situation, PT checks the intrinsic and common pathway situation.

Heparin decreases the activation of extrinsic pathway, coumadin decreases the activation of intrinsic and common pathway.

That's why one lab value checks the corresponding effect of one drug (heparin=PTT, coumadin=PT/INR).

About the financial issues, it would be difficult to judge such situation. Anyways, you can let the client go for cheaper but reliable brands, or explore alternatives form your client's side (community resources, social workers, free medical aids, etc.). and be a good patient advocate.

Hope this helps...

Answer 3

It would be appropriate to give the coumadin to bring the INR to the therapeutic range before stopping the heparin but 10 mg seems too high a dose. I would question the dose but not the drug.

Answer 4

Yes I would question the dose. You never give loading doses of Coumadin and 10 mg is a pretty large dose.