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3.8: Coagulation Disorders

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Venous thromboembolism (VTE) is a common disorder that comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Most clinically important pulmonary embolism arises from proximal deep vein thrombosis i.e. popliteal, femoral or iliac veins in at least 90%.

3.8.1 Deep Vein Thrombosis (Dvt) Propagative

Clinical features of Deep Vein Thrombosis includes

  • Leg pain, tenderness and swelling.
  • A palpable cord representing thrombosed vessels.
  • Discoloration, venous distention and prominence of superficial veins and cyanosis.
  • The clinical diagnosis of DVT is highly nonspecific.
  • In most patients the symptoms and signs are nonspecific.

3.8.2 PULMONARY EMBOLISM (PE)

Clinical features of PE includes

  • Transient dyspnea and tachypnea in the absence of other clinical features
  • Pleuritic chest pain, cough, haemoptysis ,pleural effusion, and pulmonary infiltrate
  • Severe dyspnea nad tachypnea and right side heart failure
  • Cardiovascular collapse with hypotension, syncope, and coma
  • Several less common and nonspecific presentation including unexplained tachycardia or arrhythmia, resistant cardiac failure, wheezing, cough, fever, apprehension and confusion.

Treatment of Venous Thromboembolism

Long term anticoagulation is required to prevent a frequency of symptomatic extension of thrombosis and/or recurrent venous thromboembolic events. Warfarin is started with initial heparin or clexane therapy and then overlapped for 4-5days.

D: Warfarin 5mg PO for 4–5 days

OR

D: Low Molecular weight Heparin 1mg/kg subcutaneous for 4–5days

OR

D: Unfractionated Heparin by 75units/kg IV followed by continuous infusion of 18units/kg/hrs.

Adolescents or children: lower loading dose then 15–25 Units /kg/hr by IV infusion or 250units/kg every 12hrs by subcutaneous injection.

Pregnant women:

D: Low Molecular weight Heparin (Clexane) 1mg/kg SC and should be monitored by anti-Xa levels.

NOTE

Warfarin therapy should be monitor by INR after 5–7 days of treatment. Heparin should be monitored by aPTT before treatment is initiated and monitor aPTT hourly until aPTT is twice of the initial.

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