Home Health Blogger

Managing the Home Health Patient on Anticoagulation Therapy

Posted by Joy Joan E. De Castro, RN, MSN on Jan 24, 2017

Home health care patients with atrial fibrillation, deep vein thrombosis, pulmonary embolism and/or artificial heart valves will likely be placed on maintenance anticoagulation therapy to reduce/eliminate blood clots. MyHomecareBiz.

Common Anticoagulants used in Long Term Therapy

Anticoagulants are often called blood thinners, but they don't really thin blood. They work by increasing the time it takes for a blood clot to form. This prevents an existing clot from increasing in size, thereby preventing a heart attack or stroke.

The most commonly prescribed anticoagulants are:home-health-anticoagulation-therapy

  • warfarin (Coumadin and Marevan)
  • dabigatran (Pradaxa)
  • apixaban (Eliquis)
  • rivaroxaban (Xarelto)
  • heparin

Home Health Careplan: Monitor Lab Results and Signs of Bleeding

The home health clinician monitoring anticoagulation therapy should review the following laboratory results for coagulation status as appropriate:

  • platelet count (normal = 150,000 to 450,000)
  • prothrombin time/international normalized ratio (PT/INR) (target range for INR in anticoagulant use (e.g. warfarin) is 2 to 3),
  • activated partial thromboplastin time (aPTT) (therapeutic APTT range is approximately 70 to 120 seconds),
  • fibrinogen (normal = 150-400 mg/dL),
  • bleeding time (normal BT values run in the range of 2-9 minutes),
  • fibrin degradation products (normal = less than 10 mcg/mL),
  • vitamin K (normal = 0.2-3.2 ng/mL),
  • activated coagulation time (ACT) (180 to 240 seconds is the usual amount of time for blood to clot with anticoagulant therapy).
  • Check stool (guaiac) and urine (Hemastix) for occult blood.
  • Assess skin and mucous membranes for signs of petechiae, bruising, hematoma formation, or oozing of blood.
  • Monitor hematocrit (Hct) (For men, 38.8 to 50 percent. For women, 34.9 to 44.5 percent)
  • Monitor hemoglobin (Hgb) (For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter).

In addition to monitoring labwork...

Monitor for adverse clotting reaction(s). (Heparin can cause thrombus formation with thrombocytopenia, or “white clot syndrome.” Warfarin may cause cholesterol microemboli that result in gangrene, localized vasculitis, or “purple toes syndrome.”)

diabetic-teaching.jpgObserve for skin necrosis, changes in blue or purple mottling of the feet that blanches with pressure or fades when the legs are elevated. (Clients on anticoagulant therapy remain at risk for developing emboli resulting in CVA or PE.)

Use with caution in clients with GI, renal and/or liver disease, alcoholism, diabetes, hypertension, hyperlipidemia, and in the elderly and premenopausal women. (Clients with CAD, diabetes, hypertension, and hyperlipidemia are at increased risk for developing cholesterol microemboli.)

Monitor for signs of bleeding: flulike symptoms, excessive bruising, pallor, epistaxis, hemoptysis, hematemesis, menorrhagia, hematuria, melena, frank rectal bleeding, or excessive bleeding from wounds or in the mouth. (Bleeding is a sign of anticoagulant overdose.)

Monitor vital signs. (Increase in heart rate accompanied by low blood pressure or subnormal temperature may signal bleeding.)

For more information on Medicare's Home Health Care Quality Indicators click here.

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