Page 1770 - Saunders Comprehensive Review For NCLEX-RN

b. Observe for bleeding gums, bruises,
nosebleeds, hematuria, hematemesis,
occult blood in the stool, and
petechiae.
c. Instruct the client regarding diet and
measures to prevent bleeding.

d. The antidote for warfarin is

phytonadione.
F. Dabigatran etexilate
1. Description
a. Dabigatran etexilate works through
direct inhibition of thrombin,
preventing the conversion of
fibrinogen into fibrin and activation of
factor XIII.
b. Current approved use is for clot
prevention associated with
nonvalvular atrial fibrillation.
c. It is administered in a fixed dose twice
daily.
2. Blood levels: No blood testing is required.
3. Interventions: Same as for warfarin, except no routine
monitoring is required.
II. Thrombolytic Medications (Box 53-3)
A. Description
1. Thrombolytic medications activate plasminogen;
plasminogen generates plasmin (the enzyme that
dissolves clots).
2. Thrombolytic medications are used early in the course
of myocardial infarction (within 4 to 6 hours of the
onset of the infarct) to restore blood flow, limit
myocardial damage, preserve left ventricular
function, and prevent death.
3. Thrombolytics are also used in arterial thrombosis,
deep vein thrombosis, occluded shunts or catheters,
and pulmonary emboli.

B. Contraindications

1. Active internal bleeding
2. History of hemorrhagic stroke
3. Intracranial problems, including trauma
4. Intracranial or intraspinal surgery within the previous
2 months
5. Thoracic, pelvic, or abdominal surgery in the previous
10 days
6. History of hepatic or renal disease

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