A nurse is caring for a client who has an overdose of dabigatran and is experiencing life-threatening bleeding. Which of the following drugs should the nurse anticipate administering as an antidote?

Lepirudin is a direct thrombin inhibitor that is used as an anticoagulant in patients with heparin-induced thrombocytopenia (HIT).It is administered as an initial intravenous bolus dose followed by a continuous intravenous infusion for 2-10 days or longer if clinically needed.The infusion rate should be adjusted to the activated partial thromboplastin time (aPTT), which is a measure of the blood’s clotting ability. An infusion pump can ensure a constant and accurate delivery of the drug at the desired rate.

Choice A is wrong because flushing the IV line with heparin before and after giving lepirudin can increase the risk of bleeding and worsening HIT.Heparin is the cause of HIT and should be avoided in patients with this condition.

Choice C is wrong because administering lepirudin as a bolus injection over 15 seconds can result in a rapid and excessive anticoagulation effect, which can increase the risk of bleeding and hemorrhage.Lepirudin should be given as a bolus injection over 15-20 minutes, followed by a continuous infusion.

Choice D is wrong because monitoring the client’s platelet count daily is not sufficient to assess the efficacy and safety of lepirudin therapy.The platelet count is not affected by lepirudin and does not reflect its anticoagulant activity.The aPTT should be monitored at least once daily and more frequently in patients with renal impairment or increased bleeding risk.The normal platelet count range is 150,000 to 450,000 platelets per microliter of blood.

ECT.ECT stands for ecarin clotting time, which is a test that measures the anticoagulant effect of bivalirudin, a direct thrombin inhibitor.Bivalirudin is used for patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic complications.ECT is the most sensitive and specific test for monitoring bivalirudin therapy.

Choice A is wrong because PT stands for prothrombin time, which is a test that measures the extrinsic pathway of coagulation and the effect of warfarin, a vitamin K antagonist.PT is not affected by bivalirudin.

Choice B is wrong because INR stands for international normalized ratio, which is a standardized way of reporting PT results and the effect of warfarin.INR is also not affected by bivalirudin.

Choice C is wrong because aPTT stands for activated partial thromboplastin time, which is a test that measures the intrinsic pathway of coagulation and the effect of heparin, an indirect thrombin inhibitor.aPTT can be used to monitor bivalirudin therapy, but it is less sensitive and specific than ECT.