Venous thromboembolism

A personal history of thromboembolic venous, arterial or cardiac disease or severe or multiple risk factors for these... 

Cardiovascular The main adverse effect of prothrombin complex concentrates is a risk of thrombosis, as patients taking oral anticoagulants have prothrombotic susceptibility factors [31, 33 ]. Reported thromboembolic complications include ischemic stroke, venous thromboembolism (venous thrombosis or pulmonary embolism), myocardial infarction, and disseminated intravascular coagulation [32 ]. 

Fondaparinux, the factor Xa-binding pentasaccharide (Arixtra, MW 1,728 Da), is prepared synthetically, unlike UFH, LMWH and danaparoid, which are obtained from animal sources. Despite only inactivating free factor Xa, clinical trials indicate that fondaparinux is an effective antithrombotic agent, both for venous thromboembolism prophylaxis and treatment, as well as for acute coronary syndrome and ST elevation myocardial infarction [4]. 

Miscellaneous—edema changes in libido breast pain, enlargement, and tenderness reduced carbohydrate tolerance venous thromboembolism ... 

MANAGING THROMOOEMOOLIC EFFECTS. The nurse monitors the patient for signs of thromboembolic effects, such as pain, swelling, tenderness in die extremities, headache, chest pain, and blurred vision. These adverse effects are reported to die primary health care provider. Patients with previous venous insufficiency, who are on bed rest for other medical reasons, or who smoke are at increased risk for tiiromboembolic effects. The nurse encourages the patient to elevate the lower extremities when sitting, if possible, and to exercise the lower extremities by walking. 

Prevention of Venous Thromboembolism in the Intensive Care Unit Patient... 

Age >40 yr, previous venous thromboembolism, chronic heart failure, acute respiratory failure, recent major surgery (within 2 wk), confined air/ground travel (>6 h duration within 1 wk of admission), inflammatory bowel disease, myocardial infarction, nephrotic syndrome, and ischemic stroke... 

Patients with cancer who develop a venous thromboembolism may benefit from long-term therapy with a low molecular weight heparin (at least the first 3-6 mo of pharmacotherapy) instead of oral warfarin... 

The risk of venous thromboembolism (VTE) is related to several easily identifiable factors including age, prior history of VTE, major surgery (particularly orthopedic procedures of the lower extremities), trauma, malignancy, pregnancy, estrogen use, and hypercoagulable states. These risks are additive. 

Venous thromboembolism (VTE) is one of the most common cardiovascular disorders in the United States. VTE is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE) resulting from thrombus formation in the venous circulation (Fig. 7-1).1 It is often provoked by prolonged immobility and vascular injury and is most frequently seen in patients who have been hospitalized for a serious medical illness, trauma, or major surgery. VTE can also occur with little or no provocation in patients who have an underlying hypercoagulable disorder. 

FIGURE 7-1. Venous circulation. (Reproduced from Haines ST, Zeolla M, Witt DM. Venous thromboembolism. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 374, with permission.)... 

DVT, deep vein thrombosis HIT, heparin-induced thrombocytopenia PAI-I, plasminogen activator inhibitor PE, pulmonary embolism SERM, selective estrogen receptor modulator VTE, venous thromboembolism. 

Venous thromboembolism most commonly develops in patients with identifiable risk factors (Table 7-1) during or following a hospitalization. Many, perhaps the majority of patients, have asymptomatic disease. Patients may die suddenly of pulmonary embolism. 

FIGURE 7-5. Treatment approach for patients with VTE. INR, International Normalized Ratio IV, intravenous LMWH, low-molecular-weight heparin PO, oral SC, subcutaneous UFH, unfractionated heparin VTE, venous thromboembolism. (Adapted from Nutescu EA. Emerging options in the treatment of venous thromboembolism. Am J Health Syst Pharm 2004 61 (Suppl 7) S16, with permission.)... 

TABLE 7-5. Weight-Based3 Dosing for UFH Administered by Continuous Intravenous Infusion for Venous Thromboembolism... 

Reproduced from Haines ST, Zeolla M, Witt DM. Venous thromboembolism. In DiPiro JT, Talbert RL, Yee GC, et al,... 

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