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Low Molecular Weight Heparin (LMWH) and Protamine Sulfate (Nursing)

by Rhonda Lawes

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    00:01 Now let's look at heparin low-molecular-weight.

    00:03 It's a little newer than unfractionated heparin and it's got some cool things.

    00:07 Enoxaprin or fondaparinux, those are 2 examples.

    00:11 So, this is really replacing unfractionated heparin for reasons that we talk about specifically in the Unfractionated Heparin Video.

    00:20 So, this is the frontline therapy.

    00:22 You'll see, most often, your patients are on a low-molecular-weight heparin.

    00:27 Just like unfractionated heparin, low-molecular-weight heparin cannot be given as a pill.

    00:32 It has to be given SubQ.

    00:35 Now, we give that in the patient's abdomen, and I told you from my personal experience, the stick was not bad at all, it just a little SubQ stick.

    00:43 But for me, personally, this medication burned like fire.

    00:48 And then your patient will have probably little areas of bruising everywhere you've given the injection, or they've given themselves the injection.

    00:56 Help your patients expect that, know that it's going to happen, and just use it as marker to know that you're rotating your sights appropriately.

    01:05 So, let's review how low-molecular-weight heparin is different from unfractionated heparin, because low-molecular-weight heparin is making by breaking unfractionated heparin into smaller pieces.

    01:18 Remember, unfractionated heparin is huge, but when we do low-molecular-weight heparin, we've just taken that big one and broken it into smaller pieces.

    01:27 Now, low-molecular-weight heparin has some preferences.

    01:30 It prefers to more specifically inactivate factor Xa, versus more widespread plasma proteins and tissues that you'll see with unfractionated heparin.

    01:41 So, low-molecular-weight plasma levels are more predictable.

    01:44 So that's why we can give them weight based.

    01:47 Remember, if your patients are obese, like I was when I received this medication, I actually had to have 2 syringes of medications when I gave it.

    01:55 So, low-molecular-weight heparin is more predictable than unfractionated heparin.

    02:02 We give it on a weight-based, fixed dose, and we usually don't have to do lab work.

    02:07 We can.

    02:08 We can use heparin anti-Xa levels if we think there's a problem, but usually, this can be given simply weight-based, it's very predictable, and we can keep our patients very safe.

    02:20 Now, the reversal for heparin is protamine sulfate.

    02:24 It's always good for you to know if we have a drug, if we get too much of it for our patient, what's the reversal agent? Remember, if someone was on warfarin, we would give what? Vitamin K.

    02:36 But for heparin, we would use protamine sulfate.

    02:40 That reverses the anticoagulant effects of heparin because it binds to the heparin.

    02:44 Now we can use this before or after surgery, if we have problems, after dialysis.

    02:50 Or if someone is excessively bleeding from heparin, we would give the reversal agent, which again, is protamine sulfate.

    02:58 We give it IV and it has rapid onset within 5 minutes.

    03:01 So we can use it with unfractionated and low-molecular-weight heparin overdosing.

    03:07 So while we're less likely to have an overdose with low-molecular-weight heparin, we can give this reversal agent protamine sulfate with both of them.

    03:18 Now, I want you to note at the bottom, we have a note there for you with a triangle with the exclamation point.

    03:24 If protamine sulfate is given to a patient who hasn't received heparin, it'll have this slight anticoagulant effect.

    03:32 Isn't that amazing? Now, I don't know why you would give protamine sulfate to a patient who hadn't had heparin, but you will have a slight anticoagulant effect.

    03:40 So this reversal agent, if you're on heparin, will actually cause some slight anticoagulation if you receive it and you haven't been on heparin.

    03:49 But protamine sulfate plus heparin equals neither drug having an anticoagulant effect.

    03:56 So that's just something for you to kind of keep in mind, just a nice-to-know.

    04:00 But it reinforces that concept that if we have a heparin overdose, meaning the patient's lab works are outside of normal values, they're too high, or the patient is showing us signs of bleeding, which just for fun, pause and see if you can list all the clinical signs and symptoms that you can think of that our patient was getting into risk of inappropriate bleeding.

    04:29 Great.

    04:30 I hope you were able to list several things like bleeding gums, blood in your body fluids.

    04:35 If the patient bumps their head and they have a change in consciousness, if they feel short of breath, if they are having chest pain.

    04:43 Those are some of the more serious ones that you can deal with when somebody's on anticoagulant therapy.

    04:48 But protamine sulfate plus heparin means neither of those drugs will cause an anticoagulant effect.

    04:57 Okay.

    04:57 So this is a review slide.

    04:59 So let's pause and take a breath and think about the other drugs we've talked about in this series.

    05:05 When we look at this as a whole, this is a snapshot.

    05:07 For people who are good at making clots, we have these 3 classes or families.

    05:12 They're in the green boxes: anticoagulants, antiplatelets, and thrombolytics.

    05:18 Now, next, we have how the mechanism of action of each one of these medications, and each of these medications are covered in our video series.

    05:26 But look down at the bottom.

    05:27 There's 2 giant drops of blood.

    05:30 We put those there to remind you that any person taking any 1 of these 3 classes, categories, or families, is at an increased risk for bleeding.

    05:41 That's the major takeaway point.


    About the Lecture

    The lecture Low Molecular Weight Heparin (LMWH) and Protamine Sulfate (Nursing) by Rhonda Lawes is from the course Cardiovascular Medications (Nursing). It contains the following chapters:

    • Low Molecular Weight Heparin (LMWH)
    • Reversal: Protamine Sulfate
    • Review: Mechanisms of Action

    Included Quiz Questions

    1. Subcutaneously
    2. Orally
    3. Intravenously
    4. Topically
    1. LMW prefers to more specifically inactivate factor Xa.
    2. LMW plasma levels are more predictable.
    3. LMW plasma levels are less predictable.
    4. LMW prefers to more specifically activate factor Xa.
    5. LMW binds with protamine sulfate to activate factor Xa.
    1. Bleeding gums
    2. Blood in body fluid
    3. Shortness of breath
    4. Increase in blood oxygen
    5. Increased hemoglobin level

    Author of lecture Low Molecular Weight Heparin (LMWH) and Protamine Sulfate (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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