A patient has started taking clopidogrel (Plavix) after experiencing a transient ischemic attack. What adverse effects are associated with this drug? (Select all that apply)

A. LMWHs produce a more stable effect on coagulation; thus, fewer lab tests are needed: Correct LMWHs have a more predictable anticoagulant response compared to unfractionated heparin, resulting in a more stable effect on coagulation. Because of their predictable response, routine monitoring of coagulation parameters, such as activated partial thromboplastin time (aPTT), is typically not required with LMWH therapy, unlike with unfractionated heparin.

B. LMWHs may be given by the oral route: Incorrect. LMWHs are administered by the subcutaneous route.

C. LMWHs have a short duration of action: Incorrect. LMWHs have a longer duration of action compared to unfractionated heparin.

D. LMWHs possess greater anticoagulant activity: incorrect. LMWHs generally have less potent anticoagulant activity compared to unfractionated heparin, but their more predictable response and longer half-life make them advantageous in many clinical scenario

A. Insert a urinary catheter to determine the residual urine. Inserting a urinary catheter may be necessary to accurately measure urinary output and assess for signs of urinary retention. However, the presence of hematuria suggests a potential bleeding complication related to heparin therapy. While monitoring urinary output is important, inserting a urinary catheter should not be the first action taken in response to hematuria. Other interventions to address the bleeding should be prioritized.

B. Hold the next dose of heparin and contact the physician. This is the correct answer. Hematuria can be a sign of a bleeding complication, which is a known side effect of heparin therapy. Holding the next dose of heparin is appropriate to prevent further bleeding, and contacting the physician ensures prompt evaluation and appropriate management of the patient's condition. The physician may decide to adjust the dose of heparin, temporarily discontinue it, or order further investigations to determine the cause of the hematuria.

C. Instruct the patient to drink adequate amounts of fluid. While maintaining hydration is important for overall health, instructing the patient to drink fluids would not directly address the underlying cause of hematuria, which may be related to a bleeding complication from heparin therapy. Holding the next dose of heparin and contacting the physician are more appropriate actions in response to hematuria.

D. Administer an additional dose of heparin subcutaneously. Administering additional heparin would exacerbate the bleeding risk and is contraindicated in the presence of hematuria. It is important to withhold further doses of heparin and seek medical guidance to address the bleeding complication.