Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks
|
|
- Terence Quinn
- 6 years ago
- Views:
Transcription
1 Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks
2
3 1. What is the most common cause of death in hospitalized patients? 1. Hospital-acquired infection 2. Pulmonary embolism 3. Myocardial infarction 4. Medication error
4 2. What s/s would indicate a pulmonary embolism? 1. Chest pain 2. Hemoptsis 3. Bradypnea 4. Tachypnea 5. 1,2,3 6. 1,2,4
5 3. Which drug requires aptt monitoring? 1. Heparin 2. Lovenox 3. Arixtra 4. 1 and 3
6 4. Arixtra, like Heparin and Lovenox is primarily excreted via the liver. 1. True 2. False
7 5. What of the following is true of Arixtra? 1. It can be used on an outpatient basis for the treatment of DVT and PE. 2. It is effective in the treatment of DVT and PE as a bolus plus infusion of unfractioned Heparin. 3. It is more effective than Lovenox at preventing VTE s. 4. It can be given either intramuscular or subcutaneously.
8 Objectives Discuss and identify clinical manifestations venous thromboembolism (VTE) Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in relation to the Critical Care setting Understand current prevention and treatment options Heparin and Lovenox Discuss Arixtra s action and side effects
9 Importance to Critical Care A predictive cohort study was completed using a sample of 300 patients that were discharged from the ICU for a predictive analysis of the development of an adverse event after discharge. The three most common adverse events were that of hospital acquired infection, hospital incurred accidents, and other complications such as deep vein thrombosis, pulmonary embolism, or myocardial infarction. Of these 300 patients, 147 developed an event, 44.9% of these events being related to either deep vein thrombosis or pulmonary embolism. Therefore, the nurse should take, record, and report vital signs on schedule as well as perform a detailed assessment prior to discharge to rule out risk factors related to the development of adverse events (Chaboyer, Thalib, Foster, Ball, & Richards, 2008).
10 VENOUS THROMBOEMBOLISM Venous thromboembolism (VTE) = deep vein thrombosis (DVT) and /or pulmonary embolism (PE). Hospitalized pt has more than 100-fold increased incidence of acute VTE than someone in the community. 900,000 episodes of VTE leading to hospitalization; - 300,000 related deaths in US
11 VENOUS THROMBOEMBOLISM PE is the most common cause of death in hospitalized pts. 650,000 patients have PE each year and of these, - 200,000 die. Misdiagnosis of PE is a common occurrence: - missed about 70% of the time. 10% of pts who develop PE die within the first hour. An additional 30% die from recurring PE (Hussey, 2009) It is estimated that 25% of deaths from PE can be prevented with appropriate diagnosis and treatment (Hussey, 2009)
12 Deep Vein Thrombosis DVT - a clot (thrombus) that forms in a large vein in the leg, pelvis, and arm. originate in venous valve pockets; sites of presumed venous stasis S/s -may be assymptomatic May be accompanied by inflammation, pain, tenderness, and redness at the site of the thrombus/ unilateral edema. Pain - aching, throbbing sensation, worsens with ambulation. Homans sign thrombus may migrate to the pulmonary vascular bed, causing a pulmonary embolism, development of pulmonary hypertension, or death.
13 Pulmonary Embolism PE thrombus travel through the right side of the heart to reach the lungs, thrombus lodges in the pulmonary blood vessels (too large to pass through the capillaries of the lungs) -section of the lung remains ventilated, but not perfused = > dead space -Thrombus usually originates in the deep veins of the legs (particularly the iliac, femoral, and popliteal veins) Other sources - right ventricle, the upper extremities, and the pelvic veins.
14 PE Signs and Symptoms S/S of PE - vary depending on the size of the emboli. Small emboli are not recognized in many cases may lodge in the pulmonary vasculature, causing pulmonary hypertension. causes dyspnea with exercise, syncope, and hypertrophy of the RV. Medium-sized emboli cause dyspnea, slight fever, a productive cough with blood-streaked sputum, tachycardia, and a pleural friction rub. Large PE occlude 75% of the pulmonary vasculature, cause sudden circulatory collapse and shock, accompanied by hypotension, weakness, paleness, diaphoresis, confusion, and decreased urinary output. Other common s/s decreased PO 2 with normal PCO 2, T-wave inversion on the ECG.
15 Virchow's Triad = 2 of these 3 conditions must be present for thrombosis to occur. Damage to venous wall Inflammation, or sepsis Trauma or injury (use of a tourniquet, IVs) Overdistention of vessel wall causing endothelial microtears Changes in volume or pattern of blood flow Venous stasis secondary to immobility Dehydration or shock states Increased age Obesity, Stroke, CHF Changes in ability of blood to coagulate or in constituency of blood Polycythemia Pharmacologic considerations, both expected and side effects Cancer Immediate postoperative periodpregnancy Three major predisposing factors: 1. stasis of blood, 2. endothelial injury, 3.hypercoagulability
16 NURSING MANAGEMENT Focus of nursing management is always to prevent the development of DVT. For the pt with DVT, the interventions include - rest the affected extremity, prevention of complications that may result from VTE, monitoring anticoagulant therapy. *** report immediately any chest pain, dyspnea, hemoptysis, or tachypnea = PE.
17 Current Treatment: Heparin Interferes with blood coagulation by blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. Prevents further extension of existing thrombi or new clot formation. No effect on existing clots. Used for prophylaxis and treatment of thromboembolic disorders, cardiac surgery Prevention of clotting in patients with MI Prevents cerebral thrombosis in progressive strokes Effectiveness of treatment may be monitored by aptt or ACT Response is variable because of binding with plasma proteins Effects may be reversed with protamine sulfate Risk of developing HIT.
18 Current Treatment: Heparin Risk for Heparin Induced Thrombocytopenia (HIT) Immune response to form antibodies against Heparin Antibodies contribute to the formation of platelet clumps
19 Current Treatment: Lovenox Lovenox (Enoxaprin) Low molecular weight heparin Mechanism- enhances activity of antithrombin III Indications- prophylaxis and treatment of thromboembolic complications after surgery Prevention of clots in patients with unstable angina and MI
20 Current Treatment: Lovenox Special considerations more predictable response than heparin because the drug is not largely bound to protein aptt not particularly useful in monitoring treatments Adjusting the dose of LOVENOX may be necessary for patients who have certain forms of kidney disease patients with moderate (creatinine clearance ml/min) and mild (creatinine clearance ml/min) renal impairment, all such patients should be observed carefully for signs and symptoms of bleeding Common side effects include mild local reactions or irritation at the site of injection, pain, bruising, and redness of skin
21 Current Treatment: Lovenox Dosages- for inpatient (hospital) treatment, Lovenox is 1 mg/kg every 12 hours administered SC or 1.5 mg/kg once a day administered SC at the same time every day. In both outpatient and inpatient (hospital) treatments, warfarin sodium therapy should be initiated when appropriate (usually within 72 hours of Lovenox). Lovenox should be continued for a minimum of 5 days and until a therapeutic oral anticoagulant effect has been achieved (International Normalization Ratio 2.0 to 3.0).
22
23
24 ARIXTRA (fondaparinux sodium) Synthetic, nonheparin coagulant specifically inhibits coagulation factor Xa It s a once-daily dose Administered subcutaneously Renal excretion (vs. hepatic in heparin)
25 Indications Drug was approved for use by the FDA in 2005 with a strong recommendation for the treatment of DVT s and PE s when administered with warfarin sodium
26 Indications Other FDA-approved indications are prophylaxis for: Hip fracture surgery Knee replacement surgery Hip replacement surgery Abdominal surgery for pts at risk for thromboembolic complications
27 Advantages of Arixtra Administered ONCE daily Subcutaneous injection with specific weight-based parameters For TREATMENT of DVT/PE: ~If patient weighs under 50 kg then administer 5 mg in 0.4 ml ~If between kg, then 7.5 mg in 0.6 ml ~If above 100 kg, then 10 mg in 0.8 ml
28 Prophylaxis Do not give prophylactically to patients under 50 kg! Above 50 kg, we ll give 2.5 mg daily The initial prophylactic dose should not be given until 6-8 hours after surgery as the patient needs to establish hemostasis
29 Other instructions The patient should begin treatment with warfain sodium as soon as possible and within 72 hours of initial Arixtra administration Usual duration of administration is 5-9 days for Arixtra; however, some patients, especially hip fracture patients may take it as long as 32 days Before discontinuation of Arixtra, the patient needs to have established a therapeutic INR of
30 Contraindications Patients with severe renal impairment (indicated by a creatinine clearance of less than 30 ml/min) Prophylaxis for patients under 50 kg Patients with active major bleeding Bacterial endocarditis Thrombocytopenia associated with a positive platelet antibody test in the presence of Arixtra Patients with a known hypersensitivity to Arixtra
31 Comparisons with UFH and LOVENOX Found to be as effective as a bolus dose with continuous infusion of unfractioned heparin in the TREATMENT of PE with a low incidence of major bleeding More effective than enoxaparin (LOVENOX) in the treatment of DVT After major orthopedic surgery, ARIXTRA had reduced the rate of VTE s by 55% compared with enoxaparin (LOVENOX)
32 Major advantage: Outpatient This drug can be administered on an outpatient basis. We encountered this drug in the ED when patients came in with suspected PE s. We initiate education and treatment in the hospital and then the patient is sent home. Patient Education is crucial!
33 Patient Education Teach patients about DVTs/PEs Teach how to administer a subcutaneous injection Educate on contraindications to the drug Emphasize the importance that they schedule followup appointments with PCP for the monitoring of warfarin levels RESEARCH!
34 Review Discuss and identify clinical manifestations venous thromboembolism (VTE) Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in relation to the Critical Care setting Understand current prevention and treatment options Heparin and Lovenox Discuss Arixtra s action and side effects
35
36 1. What is the most common cause of death in hospitalized patients? 1. Hospital-acquired infection 2. Pulmonary embolism 3. Myocardial infarction 4. Medication error
37 Answer #1 B. Pulmonary embolism
38 What s/s would indicate a pulmonary embolism? 1. Chest pain 2. Hemoptsis 3. Bradypnea 4. Tachypnea 5. 1,2,3 6. 1,2,4
39 Answer #2 6. 1,2,4 Chest pain, hemoptysis, tachycardia
40 3. Which drug requires aptt monitoring? 1. Heparin 2. Lovenox 3. Arixtra 4. 1 and 3
41 Answer #3 1. Heparin
42 4. Arixtra, like Heparin and Lovenox is primarily excreted via the liver. 1. True 2. False
43 Answer #4 False- Arixtra is primarily excreted via kidneys
44 5. What of the folowing is true of Arixtra? 1. It can be used on an outpatient basis for the treatment of DVT and PE. 2. It is effective in the treatment of DVT and PE as a bolus plus infusion of unfractioned Heparin. 3. It is more effective than Lovenox at preventing VTE s. 4. It can be given either intramuscular or subcutaneously.
45 Answer #5 1. It can be used on an outpatient basis for the treatment of DVT and PE. 2. It is effective in the treatment of DVT and PE as a bolus plus infusion of unfractioned Heparin. 3. It is more effective than Lovenox at preventing VTE s. 4. {INCORRECT} It can be given either intramuscular or subcutaneously. {CORRECT} It can only be administered SUBCUTANEOUSLY and never intramuscularly.
46 References Hussey, L. (2009). Clinical Updates: Reducing Mortality in Pulmonary Embolism through Prevention and Careful Management. Retrieved March 2, 2010, from Mosby's Nursing Consultant: Once-Daily Arixtra (Fondaparinux Sodium) for Injection, (2009). Efficacy with ease [Brochure]. GlaxoSmithKline. Le Sage, S., McGee, M., & Emed, J. (2008). Knowledge of venous thromboembolism (VTE) prevention among hospitalized patients. Journal of Vascular Nursing, 26(4), Retrieved from CINAHL database. Urden, L., Stacy, K., & Lough, M. (2009). Critical care nursing: Diagnosis and management (6 ed.). St. Louis: Mosby, Elsevier.
Venous Thromboembolism National Hospital Inpatient Quality Measures
Venous Thromboembolism National Hospital Inpatient Quality Measures Presentation Overview Review venous thromboembolism as a new mandatory measure set Outline measures with exclusions and documentation
More informationDr. Rami M. Adil Al-Hayali Assistant Professor in Medicine
Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality
More informationPE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP
PE and DVT Dr Anzo William Adiga WatsApp or Call +256777363201 Medical Officer/RHEMA MEDICAL GROUP OBJECTIVES DEFINE DVT AND P.E PATHOPHYSIOLOGY OF DVT CLINICAL PRESENTATION OF DVT/PE INVESTIGATE DVT MANAGEMENT
More informationMisunderstandings of Venous thromboembolism prophylaxis
Misunderstandings of Venous thromboembolism prophylaxis Veerendra Chadachan Senior Consultant Dept of General Medicine (Vascular Medicine and Hypertension) Tan Tock Seng Hospital, Singapore Case scenario
More informationPULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT
PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT OBJECTIVE: To provide a diagnostic algorithm and treatment options for patients with acute pulmonary embolism (PE). BACKGROUND: Venous thromboembolism (VTE)
More informationTitle: Low Molecular Weight Heparins (LMWH), fondaparinux (Arixtra)
Origination: 03/29/05 Revised: 09/01/10 Annual Review: 11/20/13 Purpose: To provide guidelines and criteria for the review and decision determination of requests for medications that requires prior authorization.
More informationUpdates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis. By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan
Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan Objectives Describe the prevalence of PE and DVT as it relates
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationPulmonary Thromboembolism
Pulmonary Thromboembolism James Allen, MD Epidemiology of Pulmonary Embolism 1,500,000 new cases per year in the United States Often asymptomatic 300,000 deaths per year DVT or PE present in 10% of ICU
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 02.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationVenous Thromboembolism Prophylaxis
Approved by: Venous Thromboembolism Prophylaxis Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: Date Approved January
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4
TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:
More informationCURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
More informationReducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge
Reducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge What is a venous thromboembolism (VTE)? This is a medical term that describes a blood clot that develops in a deep vein
More informationDVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
More informationHEPARIN-INDUCED THROMBOCYTOPENIA (HIT)
HEPARIN-INDUCED THROMBOCYTOPENIA (HIT) OBJECTIVE: To assist clinicians with the investigation and management of suspected and documented heparin-induced thrombocytopenia (HIT). BACKGROUND: HIT is a transient,
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationPULMONARY EMBOLISM -CASE REPORT-
University Goce Delcev, Faculty of Medical sciences, Stip University Clinic of Cardiology, Skopje R. Of Macedonia PULMONARY EMBOLISM -CASE REPORT- Gordana Kamceva MD mr.sci Acknowledgment Marija Vavlukis
More informationPathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University
Pathology of pulmonary vascular disease Dr.Ashraf Abdelfatah Deyab Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pulmonary vascular disease Type of pulmonary circulation: Types
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationMabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
More informationInhixa (Enoxaparin Sodium)
Inhixa (Enoxaparin Sodium) P R E V ENTIS SAFETY D E V I C E P R E V E N T I S I S A N AU TO M AT I C N E E D L E S H I E L D I N G S Y S T E M, W H I C H H A S A C O V E R T H AT E X T E N D S O V E R
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationObesity, renal failure, HIT: which anticoagulant to use?
Obesity, renal failure, HIT: which anticoagulant to use? Mark Crowther with thanks to Dr David Garcia and others. This Photo by Unknown Author is licensed under CC BY-SA 1 2 Drug choices The DOACs have
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More informationPulmonary embolism. Paweł Balsam
Pulmonary embolism Paweł Balsam Venous thromboembolism (VTE) Pulmonary embolism (PE) and deep vein thrombosis (DVT) are two clinical presentations of veonus thromboembolism Pulmonary embolism A pulmonary
More informationJordan M. Garrison, MD FACS, FASMBS
Jordan M. Garrison, MD FACS, FASMBS Peripheral Arterial Disease (PAD) Near or Complete obstruction of > 1 Peripheral Artery Peripheral Venous reflux Disease Varicose Veins Chronic Venous Stasis Ulcer Disease
More informationWMC PHARMACY ANTICOAGULATION PROTOCOL Current Revision: July 2017 GENERAL ORDER PROCESSING AND MANAGEMENT
WMC PHARMACY ANTICOAGULATION PROTOCOL Current Revision: July 2017 GENERAL ORDER PROCESSING AND MANAGEMENT - Entering orders for anticoagulation in Cerner Providers will enter individual orders (oneoffs)
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationNanik Hatsakorzian Pharm.D/MPH
Pharm.D/MPH 2014 1 Therapeutics FDA indication & Dosing Clinical Pearls Anticoagulants Heparin Antiphospholipid antibody syndrome Cerebral thromboembolism Prosthetic heart valve Acute coronary syndrome
More informationNew Antithrombotic and Antiplatelet Drugs in CAD : (Factor Xa inhibitors, Direct Thrombin inhibitors and Prasugrel)
New Antithrombotic and Antiplatelet Drugs in CAD : (Factor Xa inhibitors, Direct Thrombin inhibitors and Prasugrel) Limitations and Advantages of UFH and LMWH Biological limitations of UFH : 1. immune-mediated
More informationDEEP VEIN THROMBOSIS (DVT): TREATMENT
DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada
More informationNOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE VENOUS THROMBOEMBOLISM PROPHYLAXIS SCOPE Provincial Acute and Sub-Acute Care Facilities APPROVAL AUTHORITY Alberta Health Services Executive Committee SPONSOR Vice President, Quality and Chief Medical
More informationPulmonary embolism. Paweł Balsam MD, PhD
Pulmonary embolism Paweł Balsam MD, PhD Venous thromboembolism (VTE) Pulmonary embolism (PE) and deep vein thrombosis (DVT) are two clinical presentations of veonus thromboembolism Pulmonary embolism A
More informationHEMODYNAMIC DISORDERS
HEMODYNAMIC DISORDERS Normal fluid homeostasis requires vessel wall integrity as well as maintenance of intravascular pressure and osmolarity within certain physiologic ranges. Increases in vascular volume
More informationHemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.
Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators
More informationDVT and Pulmonary Embolus. Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre
DVT and Pulmonary Embolus Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre Overview Structure of deep and superficial venous system of upper
More informationINDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY
INDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY N.E. Pearce INTRODUCTION Preventable death Cause of morbidity and mortality Risk factors Pulmonary embolism
More informationShock, Hemorrhage and Thrombosis
Shock, Hemorrhage and Thrombosis 1 Shock Systemic hypoperfusion due to: Reduction in cardiac output Reduction in effective circulating blood volume Hypotension Impaired tissue perfusion Cellular hypoxia
More informationDVT - initial management NSCCG
Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis
More informationNitroglycerin and Heparin Drip Interfacility Protocols
Nitroglycerin and Heparin Drip Interfacility Protocols EMS Protocol This protocol applies to nitroglycerin and Heparin drips that are initiated at the transferring facility prior to transport and are not
More informationWhat are blood clots?
What are blood clots? Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service GP Partner Westcliffe Medical Group Created 5/31/18 Dr. Matthew
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
More informationPRODUCT MONOGRAPH. (Enoxaparin sodium solution for injection, manufacturer s standard) 150 mg/ml. 120 mg/0.8 ml
PRODUCT MONOGRAPH Pr LOVENOX (Enoxaparin sodium solution for injection, manufacturer s standard) 100 mg/ml 30 mg/0.3 ml 40 mg/0.4 ml 60 mg/0.6 ml 80 mg/0.8 ml 100 mg/ml 300 mg/3 ml Pr LOVENOX HP (Enoxaparin
More informationAnticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT
Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet
More informationVTE Management in Surgical Patients: Optimizing Prophylaxis Strategies
VTE Management in Surgical Patients: Optimizing Prophylaxis Strategies VTE in Surgical Patients: Recognizing the Patients at Risk Pathogenesis of thrombosis: Virchow s triad and VTE Risk Hypercoagulability
More informationCHAPTER 2 VENOUS THROMBOEMBOLISM
CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology
More information10/24/2013. Heparin-Induced Thrombocytopenia (HIT) Anticoagulation Management in ECMO Therapy:
Anticoagulation Management in ECMO Therapy: Heparin-Induced (HIT) Michael H. Creer, MD Professor of Pathology Director, Clinical Laboratories, Medical Co- Director, Hematopathology and Chief, Division
More informationHeparin-Induced Thrombocytopenia. Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital
Heparin-Induced Thrombocytopenia Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital Heparin-induced thrombocytopenia (HIT) A serious concern associated with thrombosis development following
More informationVenous Thromboembolism (VTE)
Venous Thromboembolism (VTE) Nursing A guide for patients and carers Contents Why do blood clots form in veins?... 1 How common is a deep vein thrombosis (DVT) or pulmonary embolus (PE)?... 2 How are DVTs/
More informationDr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust
MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital
More informationRisk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD
Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationVenous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD
Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationVENOUS THROMBOEMBOLISM PHARMACOLOGY. University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D
VENOUS THROMBOEMBOLISM PHARMACOLOGY University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D LEARNING OBJECTIVES Know what factors anticoagulant medications
More informationPrevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales
Prevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales Merimbula, 6 th November 2010 University of Sydney Department of Surgery Westmead Hospital
More informationPRODUCT MONOGRAPH. fondaparinux sodium injection. 2.5 mg/0.5 ml 5.0 mg/0.4 ml 7.5 mg/0.6 ml 10.0 mg/0.8 ml. ATC Classification: B01AX05
PRODUCT MONOGRAPH Pr ARIXTRA fondaparinux sodium injection 2.5 mg/0.5 ml 5.0 mg/0.4 ml 7.5 mg/0.6 ml 10.0 mg/0.8 ml ATC Classification: B01AX05 Synthetic Antithrombotic Aspen Pharmacare Canada Inc 111
More informationOrthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
More informationShared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins
Tameside Hospital NHS Foundation Trust and NHS Tameside and Glossop Shared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins Version 5.2 Version: 5.2 Authorised by: Joint Medicines
More informationFactor Xa Inhibition in the Management of Venous Thromboembolism: Important Safety Information. Important Safety Information (cont d)
Factor Xa Inhibition in the Management of Venous Thromboembolism: The Role of Fondaparinux WARNING: SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with
More informationPulmonary Embolectomy:
Pulmonary Embolectomy: Recommendation for early surgical intervention Tomas A. Salerno, M.D. Professor of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Epidemiology
More informationBlood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy
Blood Thinner Agent Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Outline: Blood thinner agent definition. anticoagulants drugs. Thrombolytics. Blood thinner agent Therapeutic interference
More informationPreventing Blood Clots in Adult Patients
Manchester Royal Eye Hospital Surgical Services Information for Patients Preventing Blood Clots in Adult Patients This leaflet will give you information on how to reduce the risk of developing blood clots
More informationOctober 2017 Pulmonary Embolism
October 2017 Pulmonary Embolism Prof. Ahmed BaHammam, FRCP, FCCP Professor of Medicine College of Medicine King Saud University 1 Objectives Epidemiology Pathophysiology Diagnosis Massive PE Treatment
More informationProstate Biopsy Alerts
Prostate Biopsy Alerts Saskatchewan Prostate Assessment Pathway Guidelines for the Primary Care Provider for Patient Preparation and the Management of Medications and Complications September 2016 Table
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationOutpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2015
Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2015 General Principles: There is compelling data in the medical literature to support
More informationGENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4
down ADULT POST-OPERATIVE 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to: Post Anesthesia Care Unit (PACU),
More informationHandbook for Venous Thromboembolism
Handbook for Venous Thromboembolism Gregory Piazza Benjamin Hohlfelder Samuel Z. Goldhaber Handbook for Venous Thromboembolism Gregory Piazza Cardiovascular Division Harvard Medical School Brigham and
More informationGuidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban
Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting
More informationADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4
ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Attending Surgeon: Medical Record Number Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART
More informationThese are guidelines only and can be deviated from if it is thought to be in the patient s best interest.
Clinical Guideline Venothromboembolism prophylaxis: Trauma and Orthopaedics Venous thromboembolism (VTE) is a recognised complication associated with inactivity and surgical procedures. Therefore, all
More informationCADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm
CADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm P. Timothy Pollak, MD, PhD University of Calgary Rocky Mountain/ACP Internal Medicine Meeting,
More informationTHROMBOSIS RISK FACTOR ASSESSMENT
Name: Procedure: Doctor: Date: THROMBOSIS RISK FACTOR ASSESSMENT CHOOSE ALL THAT APPLY EACH RISK FACTOR REPRESENTS 1 POINT Age 41 60 years Minor Surgery Planned History of Prior Major Surgery (< 1 month)
More informationUnderstanding Best Practices in Anticoagulation Therapy in Patients with Venous Thromboembolism. Rajat Deo, MD, MTR
Understanding Best Practices in Anticoagulation Therapy in Patients with Venous Thromboembolism Rajat Deo, MD, MTR Director of Translational Research in Cardiac Arrhythmias Division of Cardiovascular Medicine
More informationPulmonary Embolism Pathway
Pulmonary Embolism Pathway Ambulatory Care Pathway Dr. A. Zafar, Dr. A. Rehman, Dr. T. Malik September, 2011. Patient Identification Label Pulmonary Embolism Pathway Clinical History Comments Hospital
More informationDisturbance of Circulation Hemodynamic Disorder
Disturbance of Circulation Hemodynamic Disorder 2/17/2017 By Dr. Hemn Hassan Othman PhD, Pathology Fall 2016 1 Thrombosis Definition: Thrombosis is the formation of solid or semisolid blood clot within
More informationVENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?
VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital
More informationElements for a Public Summary Overview of disease epidemiology
VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Indication: Treatment of blood clots Blood clots in the large veins of the legs, known as deep vein thrombosis (DVT), are a common
More informationNew Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY
New Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY Fact VTE is deadly! It nibbles after it bites! The 30-day mortality rates for first-time DVT or
More informationUW MEDICINE PATIENT EDUCATION. Treating Blood Clots. What is a blood clot? DRAFT
UW MEDICINE PATIENT EDUCATION Treating Blood Clots About deep vein thrombosis (DVT) and pulmonary embolism (PE) and how they are treated This handout explains blood clots, their symptoms, and how they
More informationTable 4. Efficacy of ARIXTRA Injection in the Prophylaxis of Thromboembolic Events Following Knee Replacement Surgery
Table 4. Efficacy of ARIXTRA Injection in the Prophylaxis of Thromboembolic Events Following Knee Replacement Surgery Endpoint Fondaparinux Sodium 2.5 mg SC 1 Enoxaparin Sodium 30 mg SC every 12 hours
More informationAcute Pulmonary Embolism and Deep Vein Thrombosis. Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center COPYRIGHT
Acute Pulmonary Embolism and Deep Vein Thrombosis Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center Acute PE and DVT No disclosures. Acute PE and DVT Learning objectives
More informationHeparin-Induced Thrombocytopenia causing Adrenal Insufficiency
Heparin-Induced Thrombocytopenia causing Adrenal Insufficiency NATASHA MALKANI, MD LAHEY CLINIC INTERNAL MEDICINE, PGY-2 TUFTS UNIVERSITY SCHOOL OF MEDICINE Objective Describe mechanism of HIT Describe
More informationVenothromboembolism prophylaxis: Trauma and Orthopaedics Clinical guideline, V2
Clinical Guideline Venothromboembolism prophylaxis: Trauma and Orthopaedics 11/11/11 TEMPORARY GUIDANCE There is no prophylactic tinzaparin available in the Trust currently. Please substitute enoxaparin
More informationNICE Guidance: Venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital 1
The College of Emergency Medicine Patron: HRH The Princess Royal Churchill House Tel +44 (0)207 404 1999 35 Red Lion Square Fax +44 (0)207 067 1267 London WC1R 4SG www.collemergencymed.ac.uk CLINICAL EFFECTIVENESS
More informationPulmonary Embolism. Thoracic radiologist Helena Lauri
Pulmonary Embolism Thoracic radiologist Helena Lauri 8.5.2017 Statistics 1-2 out of 1000 adults annually are diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) About half of patients
More informationAnticoagulation. MPharm Programme & OSPAP Programme. Tania Jones Senior Lecturer in Pharmacy Practice & Therapeutics
MPharm Programme & OSPAP Programme Anticoagulation Tania Jones Senior Lecturer in Pharmacy Practice & Therapeutics tania.jones@sunderland.ac.uk Lecture MPHM13 / MPHM14 2017-2018 MPHM13 & MPHM14 Objectives
More informationAnticoagulation Overview Jed Delmore, MD, FACS, FACOG Professor Obstetrics and Gynecology University of Kansas School of Medicine, Wichita
Anticoagulation Overview 2018 Jed Delmore, MD, FACS, FACOG Professor Obstetrics and Gynecology University of Kansas School of Medicine, Wichita The ideal lecture is like a miniskirt. Short enough to get
More informationREVIEW ON PULMONARY EMBOLISM
REVIEW ON PULMONARY EMBOLISM * Shashi Kumar Yadav, Prof. Xiao Wei, Roshan Kumar Yadav, Sanjay Kumar Verma and Deepika Dhakal * Department of Medicine, Clinical College of Yangtze University, The first
More informationThrombolysis in PE. Outline. Disclosure. Overview on Pulmonary Embolism. Hot Topics in Emergency Medicine 2012 Midyear Clinical Meeting
Disclosure Thrombolysis in PE Daniel P. Hays, PharmD, BCPS, FASHP reports no relevant financial relationships. Daniel P. Hays, PharmD, BCPS, FASHP Outline 55 YOF presents to ED with SOB PMH of DVT + noncompliance
More informationDeep Vein Thrombosis and Pulmonary Embolism in the Perioperative Patient
...PRESENTATIONS... Deep Vein Thrombosis and Pulmonary Embolism in the Perioperative Patient Based on a presentation by James E. Muntz, MD Presentation Summary Approximately 500,000 cases of deep vein
More informationPage 1 of 6. Low 1 (score 0-3) Monitor platelets and signs and symptoms of thrombosis and continue heparin
Page 1 of 6 Estimate probability of HIT using the Four T s 1 Low 1 (score 0-3) Intermediate 1 (score 4-5) or High 1 (score 6-8) Monitor platelets and signs and symptoms of thrombosis and continue heparin
More informationOBSTETRIC ADMISSION ORDERS 1 of 4
OBSTETRIC ADMISSION 1 of 4 Actual Estimated Weight kg Actual Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART ADMIT TO: Labor and Delivery ( ) Check, circle and/or fill in all orders
More informationObjectives DVT PE 5/11/2011. Venous Thromboembolism (VTE) Venous Thromboembolism (VTE) Virchow s Triad. VTE Incidence
Objectives Current Concepts in the Diagnosis and Management of Venous Thromboembolism 1. Discuss antithrombotic treatment options for venous thromboembolism. 2. Describe the role of thrombolytic therapy
More informationADVANCES IN ANTICOAGULATION
ADVANCES IN ANTICOAGULATION The Clinicians Perspective Claudine M. Lewis Cardiologist OUTLINE Indications for anticoagulants Review - Physiology of Hemostasis Types of anticoagulants New anticoagulants
More informationTHROMBOSIS AND BLEEDING
THROMBOSIS AND BLEEDING Klara Gadó MD. PhD. Senior Professor of Internal Medicine Semmelweis University, Budapest What is thrombosis? formation of a blood clot in a blood vessel Blood can not flow Organ
More informationUniversity Journal of Medicine and Medical Specialities
University Journal of Medicine and Medical Specialities Volume 1 Issue 1 2015 An unusual case of SADDLE Pulmonary Thrombo Embolism Boopathirajan P Jayanthi R Stanley Medical College Abstract: Pulmonary
More information