Pharmacologic: thrombin inhibitors
Prevention of deep vein thrombosis (DVT) after hip-replacement surgery.
Selectively inhibits free and clot-bound thrombin. Inhibition of thrombin prevents activation of factors V, VIII, and XII; conversion of fibrinogen to fibrin; platelet adhesion and aggregation. Therapeutic Effects: Decreased incidence of DVT and subsequent pulmonary embolism after hip-replacement surgery.
Adverse Reactions/Side Effects
GI: nausea. Hemat: BLEEDING, anemia. Local: injection site reactions, wound secretion.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately of these signs.
To help monitor drug effects, be alert for signs of DVTs (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician or nursing staff immediately if these signs occur, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.
Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, pallor, and cyanosis. Notify physician or nursing staff immediately if these signs occur.
Assess any wounds or suture lines for possible secretion and bleeding. Report any suspicious wound drainage to the physician or nursing staff.
Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician or nursing staff.
Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.
Absorption: Completely absorbed following subcutaneous administration.
Distribution: Binds specifically and directly to thrombin.
Metabolism and Excretion: 40–50% excreted unchanged by kidneys; some metabolism in kidneys and pancreas.
TIME/ACTION PROFILE (effect on aPTT)
|ROUTE ||ONSET ||PEAK ||DURATION |
|SC ||rapid ||1–3 hr ||12 hr |
Contraindicated in: Hypersensitivity to natural or recombinant hirudins; Active bleeding; Coagulation disorders.
Use Cautiously in: Renal impairment (dosage change recommended if CCr ≤60 mL/min); Geriatric patients (due to age-related renal impairment); Hepatic impairment; Pregnancy (use only if benefits to mother outweigh fetal risk); Lactation, children (safety not established).
Exercise Extreme Caution in: Spinal/epidural anesthesia (increased risk of spinal/epidural hematomas and their sequelae, especially when used with NSAIDs, platelet inhibitors, or other anticoagulants).