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.
The home health clinician monitoring anticoagulation therapy should review the following laboratory results for coagulation status as appropriate...
Monitor Labwork
- prothrombin time/international normalized ratio (PT/INR) (target range for INR in anticoagulant use (e.g. warfarin) is 2 to 3),
- platelet count (normal = 150,000 to 450,000)
- 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).
- hematocrit (Hct) (For men, 38.8 to 50 percent. For women, 34.9 to 44.5 percent)
- hemoglobin (Hgb) (For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter).
Monitor for Signs of Bleeding
- Check stool (guaiac) and urine (Hemastix) for occult blood.
- Monitor vital signs - increase in heart rate accompanied by low blood pressure or subnormal temperature may signal bleeding.
- Assess skin and mucous membranes for signs of excessive bleeding:
- excessive bruising
- pallor
- epistaxis
- hemoptysis
- hematemesis
- menorrhagia
- hematuria
- melena
- frank rectal bleeding
- excessive bleeding from wounds or in the mouth
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:
- warfarin (Coumadin and Marevan)
- dabigatran (Pradaxa)
- apixaban (Eliquis)
- rivaroxaban (Xarelto)
- heparin
Anticoagulants must be used with caution in patients with GI, renal and/or liver disease, alcoholism, diabetes, hypertension, hyperlipidemia, and in the elderly and premenopausal women as they are at increased risk for developing cholesterol microemboli.
