A nurse is caring for a client who is receiving bivalirudin IV for a PCI procedure. Which of the following laboratory tests should the nurse monitor to evaluate the effectiveness of the drug?

• Dabigatran is a direct thrombin inhibitor that prevents the formation of blood clots.

It is used to treat atrial fibrillation, deep vein thrombosis, and pulmonary embolism.However, it can also cause bleeding complications, especially in high doses or in clients who have renal impairment, liver disease, or other risk factors.

• Idarucizumab is a monoclonal antibody that binds to dabigatran and reverses its anticoagulant effect.It is the only specific antidote for dabigatran overdose and should be administered intravenously as soon as possible.

• Choice A. Vitamin K is wrong because it is not an antidote for dabigatran.Vitamin K is used to reverse the effect of warfarin, a vitamin K antagonist that inhibits the synthesis of clotting factors.

• Choice B. Protamine sulfate is wrong because it is not an antidote for dabigatran.Protamine sulfate is used to reverse the effect of heparin, an indirect thrombin inhibitor that enhances the activity of antithrombin.

• Choice D. Aminocaproic acid is wrong because it is not an antidote for dabigatran.Aminocaproic acid is used to treat bleeding caused by excessive fibrinolysis, such as in hemophilia or after surgery.

Thrombolytic agents:

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.