Heparin & Enoxaparin Overdose Case Study

This nursing reflection paper examines a case where a patient received both heparin and enoxaparin simultaneously, resulting in a decreased hemoglobin and hematocrit level requiring a blood transfusion. The incident highlights the importance of thorough medication chart review and clear communication during patient handover to prevent such adverse outcomes.

1Running head:NURSING
Nursing
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NURSING
The present reflection paper is about a situation observed during the Practicum
Experience. A patient was brought into the emergency room. Upon examining his condition
he was administered a heparin bolus, and subsequently heparin infusion was started. When
transferred to the critical care unit, the physician prescribed enoxaparin for the patient. The
physician was not informed that the patient was already on a heparin bolus. The patient
received both heparin and enoxaparin for 15 hours that led to a decrease in the hemoglobin
and hematocrit levels. The patient had to be given a blood transfusion.
Heparin is a heterogenous group of mucopolysaccharides that is administered to a
patient due to its anticoagulation properties for preventing the formation of blood clots in the
body, such as venous thrombosis, pulmonary embolisms and coronary artery clots. When
heparin bolus is administered prior to infusion of the same, minimum therapeutic range is
faster than therapy without heparin bolus. (Mulloy et al., 2016). In the present case, it was an
appropriate approach to administer heparin bolus prior to commencing on heparin infusion.
Enoxaparin is a form of the drug known as “low molecular weight heparin” (LMWH), which
also acts by preventing blood clot, though the composition of the drug is different from that
of heparin (Erkens&Prins, 2013). Valgimigli et al., (2015) highlight that long-term heparin
use is associated with complications including platelet dysfunction, thrombocytopenia and an
increased risk of haemorrhage. The administration of both heparin and enoxaparin was the
cause of the drop in the hemoglobin and hematocrit.
The responsibility of the physician was to follow the medication chart outlined for the
patient prior to commencing on any medication. Non-compliance to this safety measure led to
the poor patient outcome. Patient handover within two departments in a clinical setting needs
to be supported by adequate communication of patient information (Manser et al., 2013). The
situation would not have arisen if the physician had considered the medication chart while
outlining future treatment regimen.

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NURSING
References
Erkens, P. M. G., &Prins, M. H. (2013). Fixed dose subcutaneous low molecular weight
heparins versus adjusted dose unfractionated heparin for venous
thromboembolism. The role of primary and secondary care in the management of
pulmonary embolism, 73.
Manser, T., Foster, S., Flin, R., &Patey, R. (2013). Team communication during patient
handover from the operating room: more than facts and figures. Human factors, 55(1),
138-156.
Mulloy, B., Hogwood, J., Gray, E., Lever, R., & Page, C. P. (2016).Pharmacology of heparin
and related drugs. Pharmacological reviews, 68(1), 76-141.
Valgimigli, M., Frigoli, E., Leonardi, S., Rothenbühler, M., Gagnor, A., Calabrò,
P., ...&Repetto, A. (2015). Bivalirudin or unfractionated heparin in acute coronary
syndromes. New England Journal of Medicine, 373(11), 997-1009.