Question

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level."
B. "I will call the provider to get a prescription for discontinuing the IV heparin today."
C. "Both heparin and warfarin work together to dissolve the clots."
D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

Answer 1

The nurse should explain that a dual anticoagulant regimen is needed because while heparin acts quickly, warfarin takes several days to reach effective levels in the blood. Thus, heparin is used to provide immediate anticoagulation, and warfarin is started concurrently to ensure a seamless transition and continuous anticoagulation during the treatment of deep vein thrombosis.

Step-by-step explanation:

The correct answer to the client's question about why both heparin and warfarin are necessary in the treatment of deep vein thrombosis (DVT) is: “Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.” This explanation is necessary because heparin and warfarin work through different pathways and have different onset times. Heparin acts quickly and can provide immediate anticoagulation, whereas warfarin needs several days to achieve therapeutic levels in the blood because it affects the vitamin K-dependent clotting factors and thus requires time for the pre-existing clotting factors to degrade.

Heparin, an anticoagulant substance, opposes coagulation and supports the management of DVT by affecting several clotting factors immediately upon administration. In contrast, warfarin is a vitamin K antagonist that slowly decreases the production of vitamin K-dependent clotting factors by the liver. By overlapping the therapy, the patient is ensured continuous anticoagulation while transitioning from heparin, which has a short-acting effect, to warfarin, which has a longer duration of action but takes time to become effective. The transition ensures adequate anticoagulation, preventing new clot formation and allowing the body time to resolve the existing clot.