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  • Image not available. The risk of venous thromboembolism (VTE) is related to several easily identifiable factors, including age, major surgery (particularly orthopedic procedures of the lower extremities), previous VTE, trauma, malignancy, prolonged immobility or limb paralysis, and hypercoagulable states. These risks are additive.
  • Image not available. The diagnosis of VTE should be confirmed by objective testing.
  • Image not available.Antithrombotic therapies require meticulous and systematic monitoring as well as ongoing patient education. Well-organized anticoagulation management services improve the quality of patient care and reduce overall cost.
  • Image not available. Bleeding is the most common adverse effect associated with anticoagulant drugs. A patient's risk of major hemorrhage is related to the intensity and stability of therapy, concurrent drug use, history of gastrointestinal bleeding, history of prior noncadioembolic stroke, renal or hepatic impairment, thrombocytopenia, recent surgery or trauma, and increasing age.
  • Image not available. At the time of hospital admission, all patients should receive prophylaxis against venous thromboembolism that corresponds to their level of risk. Prophylaxis should be continued throughout the period of risk.
  • Image not available. In the absence of contraindications, the treatment of VTE should initially include a rapid-acting anticoagulant (e.g., unfractionated heparin, low-molecular-weight heparin, or fondaparinux). If the patient is transitioned to warfarin therapy, the rapid-acting anticoagulant should be overlapped with warfarin for at least 5 days and until the patient's international normalized ratio is greater than 2.0. Anticoagulation therapy should be continued for a minimum of 3 months. The duration of anticoagulation therapy should be based on the patient's risks of VTE recurrence and major bleeding, and preference regarding continued treatment.
  • Image not available. Most patients with an uncomplicated deep vein thrombosis, with or without pulmonary embolism, can be safely treated as an outpatient.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the processes of hemostasis and thrombosis - specifically the role of the vascular endothelium, platelets, coagulation cascade, and thrombolytic proteins.
  • 2. Discuss the pathogenesis of deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • 3. Stratify a patient’s risk of developing venous thrombosis.
  • 4. Recognize the signs and symptoms of deep vein thrombosis and pulmonary embolism.
  • 5. Compare and contrast the mechanisms of action of antithrombotic drugs: warfarin, unfractionated heparin (UFH), the low-molecular-weight heparins (LMWHs), fondaparinux, and the direct thrombin inhibitors.
  • 6. State at least two potential advantages of the LMWHs and fondaparinux over UFH.
  • 7. Analyze the advantages and disadvantages of antithrombotic drugs in terms of their pharmacokinetic and pharmacodynamic properties.
  • 8. Identify factors that place a patient at high risk of bleeding while receiving antithrombotic drugs.
  • 9. Formulate a prevention strategy for a patient at high risk for deep vein thrombosis consistent with the clinical practice guidelines.
  • 10. Formulate a treatment plan for a patient who develops a deep vein thrombosis or pulmonary embolism consistent with clinical practice guidelines.
  • 11. Identify warfarin drug-drug and drug-food interactions and state their potential impact on a patient’s coagulation status.
  • 12. Formulate an appropriate treatment plan for a patient who develops heparin-induced thrombocytopenia consistent with clinical practice guidelines.
  • 13. Select and interpret laboratory test(s) commonly ...

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