2. *
Endothelial cells + platelets + coagulation proteins
All stick together to form a clot to promote hemostasis
when there is injury to the vascular system
Injury can come from
trauma, surgery, and fractures
3. *
Xarelto is an anticoagulant that inhibits platelet
aggregation, thereby prevents a blood clot from
forming (a-fib) and treats acute clots that form
in the lungs (PE) and in the lower legs (DVT)
5. Disadvantages to Lovenox /
Heparin and Coumadin
combination therapies
Lovenox and Heparin: Coumadin:
Not oral Drug interactions
Frequent monitoring Food interactions
Injection site reactions Narrow therapeutic range
6. *Advantages to Xarelto:
Dosed daily
No monitoring
No injection sites
Bioavailability is 80-100%
Onset is 2-4 hours
Half Life is 5-9 hours
Great for patients who are non compliant with
getting blood checked
Great for patients who you can’t stabilize their
INR
7. *Uncontrolled bleeding
*Development of spinal hematoma
*Bleeding from nose, mouth, vagina, or rectum
*Headache, dizzy, feeling like you might pass
out
*Red or pink urine, black or bloody stools
*Numbness, tingling, or weakness especially in
your legs and feet, or one sided
*Loss of movement in any part of your body
9. *Who’s taking it?
Patients with A fib to prevent a STROKE
Surgical patients who need to prevent a DVT
Acute treatment of PE or DVT
Long term therapy for resolved PE or DVT
10. *Who can’t take it?
Patients who are actively bleeding (or recent
STROKE)
Pregnant women or children (>18)
Anyone with a Lactose allergy
Patients with severe renal or hepatic
impairment
Patients with Japanese ethnicity should have dose
adjusted for their body weight
11. *
*S = situation
*B = background
*A = assessment
*R = recommendation
A communication tool will be placed on every patients chart
who is taking the drug Xarelto. Medications are scheduled
for 9 am so the pharmacist assigned to the unit will run a
report by 8 am identifying all patients who are on the med
and they will place a SBAR form on each pt’s chart. Nursing
will fill the form out for all disciplines to see so they are
aware prior to interacting with the patient.
12. *
*S = pt is on blood thinner Xarelto
*B = history of blood clot in leg or lung
*A = alert and able to do PT, or scheduled for MRI
*R = recommend for LAB: no needle sticks to extremities
(potential bleeding) use PICC line for all specimens, or
recommend for PT: do not use sticky tape for wound care
(bleeding risk) if the tape gets stuck to the skin and pulls
a layer off, or recommend for PT: get pt up slowly may
be dizzy as side effect from Xarelto.
13. *
*Xarelto is new oral therapy used to treat blood clots,
prevent blood clots in surgical pt’s, and in pt’s with A fib
*More cost effective in that it doesn’t have to be monitored
by frequent blood draws, and dose doesn’t change
*Side effects are bleeding, uncontrolled bleeding, spinal
hematoma, and are exacerbated when taken with certain
medications like blood thinners, anticoagulants, & NSAIDS
*Since it can have dangerous side effects communication
among healthcare providers is crucial
*SBAR tool is great way to identify these pt’s and alert all
disciplines of the cautions to take when interacting with
pt’s on Xarelto
14. *
* http://omr.bayer.ca/omr/online/xarelto-pm-en.pdf
* Institute for Healthcare Improvement. Guidelines for communicating with
physicians using the SBAR process.
http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBARTechniq
ueforCommunicationASituationalBriefingModel.htm.
* Joint Commission of Accreditation. Candidate 2007 hospital and critical access
hospital National Patient Safety Goals (NPSGs) and requirements.
www.jcaho.org.
* Joint Commission on Accreditation of Healthcare Organizations. The Joint
Commission guide to improving staff communication. Oakbrook Terrace, IL: Joint
Commission Resources; 2005.
* O’Daniel, M., & Rosenstein, A. (2008). Patient Safety and Quality: An
Evidence-Based Handbook for Nurses. Agency for Healthcare Research and
Quality (US).
