Hypercoagulable State - Assignment Example

Hypercoagulable due: Based on Amanda’s assessment, she is suffering from hypercoagulable state. This paper will discuss how to bridge the patient (Amanda) from warfarin for cholecystectomy surgery as per the surgical bleeding risk. Amanda was at a pre-procedure INR of 2.2; therefore, warfarin discontinuation plan will be to stop warfarin five days (hold four doses) prior to the procedure. Question 1Bridging anticoagulation will be by the administration of a class of medication known as short- acting anticoagulants.

The medication of choice is low dose low molecular weight heparin (LWMH) antithrombotics; to be used before and after the surgery. This medication is Dalteparin Sodium 5000 IU o.d. The reason I chose this medication and not others is because this medication minimizes the time that patients are not therapeutically anticoagulated, thus reduces the risk of thromboembolism (Leizorovicz et al., 2004). Moreover, a fixed low dose rate of LWMH has proved to be reliable as compared to the other classes of medication.

This is because it diminishes the chances of thrombotic complications (Erkens & Prins, 2010). Question 2Amanda is to go for a cholecystectomy, as her medical practitioner, and I would recommend the following instructional points:• Blood thinners, vitamin E, aspirin, and or anti-inflammatory drugs will have to be stopped temporarily before the surgery• Keeping all scheduled laboratory appointments to monitor medication response• Always wear a medical identification bracelet so as to get the ideal medical care in case of an emergency• Visit a medical facility immediately if heavy bleeding, persistent fever over 39c, increased abdominal swelling, or bruising occursQuestion 3Adverse drug reactions include bleeding at any site, pain and reactions at the injection site, hair loss, haematoma, and type 1 thrombocytopenia.

These side effects can be managed by alerting any medical attendant so that they give the correct management guidelines. However, these side effects go away on their own after some time (Bick, 2002). Worst case scenarios include bleeding from the injection site, allergic reaction signs (swelling of the lips, face, tongue, rash, difficulty in breathing), nose bleeding, bloody stools, increased menstrual bleeding, and signs of stroke. If the mentioned worst case scenarios happen, then the patient must stop taking the medication immediately medical attention immediately.

Question 4Several drugs have been known to interact with Dalteparin i.e. platelet inhibitors, oral anticoagulants, and thrombolytics. The combination of Dalteparin with these drugs has shown that the risk outweighs the benefit. I.e. severe bleeding may be seen when the drug is combined with other blood thinning agents and anticoagulants, Dalteparin has been known to increase potassium levels when combined with ACE inhibitors. Combinations have to avoid with Dalteparin unless under special circumstances.

An applicable measure for this patient is not combining Dalteparin with any other medication (Burton, 2005). Question 5I prescribed a generic name. No, there is no available generic version for this medication. The brand name for the medication is Fragmin. The brand version of this medication is Dalteparin Sodium 5000 IU/0.2ml Solution. I prescribed this preparation (brand version) as it is the only one available currently. Question 6The cost of Dalteparin Sodium / Daltéparine Sodium Liq Injectable 5000IU Fragmin (Prefilled Syringe) is $52.

22 for one vial. This medication is not on the $4 list available at area stores. Question 7A blood test called PT-INR has to be conducted to see if Warfarin medication has been working. Five days before the surgery, INR blood test must be done. At this given day, no warfarin is to be administered. LMWH has to be administered three days before the surgery till the last day before the surgery. The last dose has to be given to the patient 24 hours before surgery, and INR blood test has to be done.

After the surgery, when there is adequate postoperative hemostasis, warfarin has to be administered. Day one after surgery, LMWH has to be administered at least 24 hours after the procedure, when there is adequate postoperative hemostasis. LMWH is then given till the fifth day after surgery. INR and CBC blood tests have to be conducted on the third and fifth day after surgery so that the Amanda’s progress can be monitored. I will know if the medication is efficacious if the patient has no blood clotting disorder after the surgery.

I would want to see the patient again after three months. Question 8Should this option fail, alternative treatment plans include• Switching a different blood thinner i.e. Arixtra injections and Xarelto. • Increasing the dosage • Adding aspirin to the blood thinnerQuestion 9Dalteparin should not be taken by pregnant women unless the benefit outweighs the possible risks. This means that Dalteparin should only be administered to a pregnant patient only when needed. Dalteparin falls under category B (Greer et al., 2007).ReferencesBick, R. L. (2002).

Disorders of thrombosis and hemostasis: Clinical and laboratory practice.Philadelphia: Lippincott Williams & Wilkins.Burton, M. (2005). Applied pharmacokinetics and pharmacodynamics: Principles of therapeuticdrug monitoring. Philadelphia [u.a.: Lippincott Williams & Wilkins.Erkens PMG, Prins MH. Fixed dose subcutaneous low molecular weight heparins versusadjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD001100. DOI: 10.

1002/14651858.CD001100.pub3.Greer, I. A., Nelson-Piercy, C., & Walters, B. (2007). Maternal medicine: Medical problems inpregnancy. Edinburgh: Churchill Livingstone.Leizorovicz, A., Cohen, A. T., Turpie, A. G., Olsson, C. G., Vaitkus, P. T., & Goldhaber, S. Z.(2004). Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation, 110(7), 874-879.