The nurse prepares discharge instructions for a patient recovering from percutaneous transluminal coronary intervention (PTCI). What medication information should the nurse include with this teaching?

Choice A rationale Ibuprofen is a nonsteroidal anti-inflammatory drug that is generally discouraged immediately following a myocardial infarction or coronary intervention. It can increase the risk of cardiovascular events, such as reinfarction or stroke, by interfering with the antiplatelet effects of aspirin. Additionally, it may cause sodium retention and increase blood pressure, which adds unnecessary strain on the healing cardiac muscle. Patients are instead educated to use acetaminophen for minor pain management to avoid these risks. Choice B rationale Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors, typically used for atrial fibrillation or prosthetic heart valves. While it prevents systemic emboli, it is not the standard medication for maintaining stent patency after a percutaneous transluminal coronary intervention. The primary concern after stent placement is platelet aggregation on the foreign metal surface. Warfarin alone does not adequately inhibit the specific pathways of platelet activation required to prevent acute or subacute stent thrombosis. Choice C rationale Plavix, or clopidogrel, is a P2Y12 receptor antagonist that inhibits platelet aggregation. Following percutaneous transluminal coronary intervention, especially with stent placement, dual antiplatelet therapy is essential. It prevents the formation of thrombi on the stent surface while the vessel wall undergoes endothelialization. Patients must be educated on the importance of strict adherence to this regimen to prevent catastrophic stent thrombosis. Common side effects include an increased risk of bruising and minor bleeding episodes. Choice D rationale Heparin is an intravenous or subcutaneous anticoagulant used in the acute hospital setting to provide immediate anticoagulation by potentiating antithrombin III. It is frequently used during the actual percutaneous procedure to prevent clotting on catheters and wires. However, it is not a discharge medication because it requires frequent monitoring of the partial thromboplastin time and is not available in a practical oral form. Long-term outpatient management relies on oral antiplatelet agents rather than heparin therapy.