A nurse is teaching a client who has a new prescription for dabigatran to prevent stroke. Which of the following instructions should the nurse include? (Select all that apply.)

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.

This statement by the client indicates a need for further teaching because aspirin can increase the risk of bleeding when taken with argatroban, which is an anticoagulant drug used to treat or prevent thrombosis in patients with heparin-induced thrombocytopenia (HIT). The client should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless prescribed by their health care provider.

Choice A is wrong because avoiding alcohol while taking argatroban is a correct statement.

Alcohol can also increase the risk of bleeding and should be avoided or limited by the client.

Choice C is wrong because notifying the dentist that the client is taking argatroban is a correct statement.

The client should inform their dentist and other health care providers about their medication history before any invasive procedures, as they may need to adjust or stop their argatroban dose to prevent excessive bleeding.

Choice D is wrong because checking the blood pressure regularly at home is a correct statement.

The client should monitor their blood pressure and other signs of bleeding, such as bruising, nosebleeds, blood in urine or stool, or prolonged bleeding from cuts or wounds.

The client should also report any symptoms of thrombosis, such as chest pain, shortness of breath, leg pain or swelling, or stroke-like symptoms.