Deep Vein Thrombosis: Symptoms and Treatment

With thrombosis of the lower extremities veins, blood clots or blood clots form cavities, which interfere with the normal movement of blood. Over time, they can clog the venous lumen and even come off, ending in the heart, lungs, and other organs (Dalen, 2016). Unfortunately, it is often impossible to timely determine the initial symptoms of thrombosis of the leg vessels. However, if the skin changes color and swelling occurs where the blood clot is located, these are signs of vascular disease.

When thrombosis progresses, its symptoms appear: acute pain and heaviness in the patients legs. These symptoms are provoked by the venous congestion below the site of thrombosis. The main causes of the diseases development are blood clotting and damage to the vein wall (Thachil & Bagot, 2018). In addition, long journeys and old age exacerbate the risk of serious problems. It is also possible that the patient is taking medications that increase blood clotting, so it is necessary to ask him about this to be sure of the diagnosis.

Ways to make an accurate diagnosis include duplex scanning, radiopaque phlebography, MRI, or CT. The combination of these methods will most accurately determine the severity and nature of the disease. After that, a doctor can prescribe a suitable treatment. Of the drugs, it can be injections of heparin and capsules of anticoagulants. If these methods do not help, then thrombolysis is necessary, which promotes resorption of blood clots. With the most severe outcome, surgery will be required. Undoubtedly, this is the last thing to do since it is always important to use all the other methods before making it. It may also be dangerous in the age of the considered patient. Thus, it is vital to use other methods and try to avoid any harmful consequences. Not only this will help cure thrombosis, but also save patients life.

References

Dalen, J. E. (2016). Venous Thromboembolism. CRC Press.

Thachil, J., & Bagot, C. (2018). Handbook of Venous Thromboembolism. John Wiley & Sons.

Managing and Preventing Venous and Arterial Thromboembolism

The Main Issue of Concern

American College of Chest Physicians (ACCP) outlined guidelines based on evidence of thrombolytic and antithrombotic therapy. The guidelines featured recommendations to healthcare services providers aiming at managing and preventing venous and arterial thromboembolism in surgical and medical patients. These recommendations are carried out on conditions such as cerebrovascular, cardiac arterial-venous thromboses, peripheral vascular disease, and in the prevention of venous thromboembolism. Despite availing the guidelines to healthcare providers, hospitalized patients still fail to receive the appropriate and adequate protection against deep vein thrombosis (DVT).

The recommendations for the management and prevention of DVT entail applying mechanical prophylactic measures whose application needs to be understood by the healthcare providers. The mechanical prophylactic prevention measures entail several actions. These measures include exercising, the use of graduated stockings or the knee-high compression stockings use, exploring a variety of motions, and the use of pneumatic devices for compression. Ensuring DVT prevention has been achieved successfully requires the healthcare providers to conduct a timely assessment of patients.

The Importance of the Issue

In the case of UMMC Hospital, it is recommendable to apply knee-high compression stocking use. This measure helps reduce venous stasis and improves the venous return in the leg veins. The knee-high compression stocking measure is easy to use, and it does not increase bleeding risk in most patients. Healthcare providers should be careful when applying this measure since it relates to patients at a lower risk for DVT development. Furthermore, the knee-high compression stocking measure applies to patients who possess the contraindication of using the pharmacological recommended measures.

The knee-high compression stocking prevention measure of DVT is easily accommodative by most patients and can be possibly continued up to the basis of outpatient. The suitable patients for this measure are the ones who have a lower risk for DVT, particularly when paired with exercises of the foot and ankle for those capable of conducting them. Caution in the use of knee-high stockings is required for individuals who possess arterial insufficiencies of lower extremities since their arterial circulation has been compromised already. To obtain an extreme benefit and avoid tight-fitting stockings resulting in a tourniquet effect, selecting a proper fit is required. The knee-high compression stocking should be applied immediately to affected patients as recommended and be removed after 30 minutes shift to allow the assessment of the underlying skin.

The ACCP guidelines recommend the knee-high compression stocking measure for all hospitalized patients with anticoagulant contraindication. The patients exposed to high risks of developing anticoagulant contraindication are recommended to combine the substance use. The knee-high compression stocking prevention measure must be applied initially to surgical patients with higher risks for bleeding until reconsideration for anticoagulant has been made. Compression modes are considered to be effective and safe, although they require to be applied for the bedrest duration and not for a particular duration in a day. Nurses are advised to encourage the use and compliance of the patients.

Anecdote

The knee-high compression stocking measure entails applying the pharmacologic prophylactic step, which uses numerous kinds of anticoagulants to reduce the coagulability of blood. The applicable anticoagulants include unfractionated heparin, aspirin, pentasaccharides, warfarin, and heparin of low-molecular-weight. Providing excellent protection requires the medication to be administered to patients possessing moderately higher risk factors which other mechanical tools only can offer. Despite aspirin being an effective treatment for the prevention of prophylaxis for arterial thrombosis since it decreases the platelets aggregation, ACCP recommended guidelines discourage their use as a sole means of venous thromboembolism in any given patient since they are ineffective to act on the venous thrombi components. Furthermore, additional tools for preventing DVT are recommended for patients taking aspirin for other treatment reasons. Unfractionated heparin needs monitoring and adjustment of the partially activated thromboplastin periods dosage plan based on the results.

Administration of heparin intravenously or subcutaneously results in either immediate provision of anticoagulant effect or delayed response of approximately 1 hour. Low-molecular-weight heparin provides a convenient and easy administration platform for patients in hospitals, with the drug being safe to be used on the elderly. The obese and renal impaired patients require dose adjustment as those with higher risks of bleeding are given low-molecular-weight heparin rather than unfractionated heparin, which ensures they have low bleeding instances. Patients in critical care and their DVT risk are moderate and require to use of prophylaxis together with low-molecular-weight heparin or heparin. Patients in high risky critical conditions require low-molecular-weight heparin. Warfarin provides a convenient pill taken orally in hospitals, and its continued at home by patients exposed to risk after being discharged. Patients should avoid certain foods since they alter warfarins effectiveness.

Consequences of Taking No Action

Failure to make dosage adjustments of low-molecular-weight heparin prophylaxis in the elderly and obese patients will lead to bleeding. Bleeding will worsen the condition of the hospitalized or the home-based patient. Failure to re-evaluate the risk factors of a patient by the nurses may worsen his/her condition. Failure to consider the patients bleeding potential when contemplating anticoagulant use by the patient advocates (nurses) may lead to delayed administration of assessment trials for DVT prevention.

Furthermore, obtained orders to administer prophylaxis for DVT risk development should be timely to initiate prevention mechanisms. Delay exposes the patients to risk factors that will be costly to rectify. Delay administering DVT treatment mechanism generates life-threatening complications such as pulmonary embolus in the patients. Furthermore, after the delay, their treatment will involve the use of costly doses, which may aggravate the bleeding problem. The costly doses will require the use of coagulants rather than prevention. Therefore, early prevention methods for all healthcare providers in patients provide the best options since they reduce DVT complication risks and avoid treatment options.

Recommendations

A combined therapy bringing together the tools of pharmacological and mechanical techniques should be adopted for patients considered to have a higher risk for DVT than those in need of lower anticoagulant doses. Furthermore, combined therapy should be recommended for the elderly since they are exposed to multiple risk aspects and increased bleeding probability. Adopting mechanical measures which possess little contraindications and are considered better adjuncts for patients requiring a reduction in dosage of measures entailing pharmacology will be appropriate.

ACCP recommended guidelines to discourage aspirins as a sole means of venous thromboembolism in any given patient since they are ineffective in acting on the venous thrombi components. Furthermore, ACCP recommended guidelines propose using unfractionated aspirins and low-molecular-weight heparin prophylaxis in all patients considered to be in an acute medical ill state without using contraindications anticoagulants for those having many risk factors for DVT prevention mechanism.

The nursing practice that entails the elimination of errors and the introduction of prevention mechanisms requires significant support from the field decision-makers (Bureau & Gordon, 2013). Healthcare providers should follow the ACCP guidelines since they provide the appropriate recent and scientifically proven recommendations to help in DVT prevention and treatment. The nurses who are patients advocates need to be aware of the risk factors which may expose the persons they represent to life-threatening conditions. Nurses should be curious about the risk factors and DVT prophylaxis to determine the appropriate use by their patients.

Reference

Bureau, B. & Gordon, S. (2013). From silence to voice: What nurses must know and communicate to the public (3rd Ed.) ILR Press/Cornell University.

Deep Vein Thrombosis: Risks, Symptoms and Tests

Risks and Symptoms of a Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a condition that is characterized by a blood clot(s) occurring in the veins inside an individual’s muscles. It mainly occurs in legs, although it can also form in the chest arms and even in other body parts. The symptoms of DVT include soreness and inflammation of body parts where the clot forms. In some cases, the clot forms in the blood vessels that carry blood to the brain, heart, or even lungs.

In such a situation, DVT becomes fatal due to organ damages. Becattini, Agnelli, and Schenone (2012, p.1959) explain that people can easily develop a suspicion that they have DVT when they experience severe inexplicable pain in their ankle or foot. Such people may also have some areas of the skin feeling warmer compared to others that surround the specific region.

The skin in the affected area turns pale, reddish, or sometimes bluish. However, the condition may not be easily detected among some people until they have undergone treatment for pulmonary embolism in an emergency condition (Geersing, Zuithoff, Kearon, & Anderson, 2014). This situation is associated with risky complications that arise from DVT.

Potential Complications from DVT

Pulmonary embolism is one of the probable complications of DVT. The artery that supplies blood to the lungs becomes blocked, often causing death in a few hours when the condition is not addressed promptly. When the complication is detected, patients are given emergency admission when a medical practitioner can help to manage the condition. Signs such as increased heart rate, cough with blood droplets, breathing rapidly, sweating, and dizziness accompany pulmonary embolism (Geersing et al., 2014). Patients may also experience chest pains, which become worse after coughing or even when taking a deep breath.

People who have had DVT may also develop post-thrombotic syndrome, which constitutes a long-term symptom. Van der et al. (2011) assert that the syndrome affects 20 percent to 40 percent of people diagnosed with DVT. The ongoing research on the causes of PTS has not arrived at a unanimous agreement on the causes of the condition.

However, Geersing et al. (2014) observe that inflammation and damaged venous valves are contributing factors. The damaged venous valves due to thrombus and obstructions of the veins because of DVT cause blood diversion to other veins, a situation that results in a rise of blood pressure. Resulting hypertension translates into the rupturing of superficial veins, hence leading to a subcutaneous flow of blood. Consequently, tissue permeability increases. The aftermath may include pain, swellings, ulceration, and the discoloration of the affected areas.

Necessary Tests to rule out DVT

A medical practitioner can only rule out any potential danger of a suspected medical condition by conducting tests that lead to the right diagnosis. In this process, he or she may have to conduct differential diagnoses (Goolsby & Grubbs, 2015). In the case of DVT, the D-dimer test is necessary. However, such a necessity depends on the clinical assessments that help to determine the appropriateness of the test. For example, for patients who are highly unlikely to have the condition, a normal D-dimer test helps in ruling out the use of any other alternative diagnosis.

This finding underlines the applicability of the principle of probability in helping to order a suitable test, which can help to rule out DVT. An apt prediction rule when diagnosing DVT entails the Wells’ score (Geersing et al., 2014). For individuals with a high probability of getting DVT, imaging is required. However, it is recommended to first complete the D-dimer test before deploying imaging using techniques such as ultrasound testing, CT scan technology, or contrast venography.

Reference List

Becattini, C, Agnelli, G, & Schenone, A. (2012). Aspirin for preventing the recurrence of venous thromboembolism, Engl J Med, 366(21), 1959–1966.

Geersing, J., Zuithoff, P., Kearon, C., & Anderson, R. (2014). Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. The BMJ, 348(1), 1340-1340.

Goolsby, J., & Grubbs, L. (2015). Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses. Philadelphia, PA: F.A. Davis Company.

Van der, V., Toll, B., Ten Cate-Hoek, J., Oudega, R., Stoffers, E., Bossuyt, M. (2011). Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients. Ann Fam Med, 9(2), 31-36.

Thrombosis and Anemia in Medical Practice

Case Study 1

In medical practice, there are a large number of diseases that develop quite quickly. Such diseases can be difficult to diagnose due to ambiguous symptoms reported by patients. The proposed case study describes the case of a racial minority patient (44 years old) who developed a pulmonary embolism after the surgical treatment of his tumor.

The things that went wrong in the case include the lack of necessary postoperative care, blood tests, and CTA tests helping to distinguish the condition (Tan & Haramati, 2016). Also, it is possible to suppose that the providers attributed the patients’ symptoms to possible heart problems or the effects of anesthetic medications used to perform surgical procedures.

The potential reasons why blood clots continued to be misdiagnosed are related to the providers’ level of professional experience and the similarities between the symptoms indicated and the signs of a heart attack. Furthermore, difficult breathing is listed among the most common effects of anesthesia and it could cause misdiagnosis (Haden, 2017). Another reason is the unique character of reported symptoms (the presence of gas pains, the absence of chest pain, unusual skin color, etc.).

There are specific strategies that could be used to prevent the development of blood clot complications and the patient’s death. Obtaining the medical history, it would be necessary to study the presence of common risk factors such as the cases of thromboembolic disease in his family medical history, an increased BMI, the history of inflammatory disease, or a sedentary lifestyle. When it comes to ordering diagnostics, it would be important to conduct blood and urine tests, do an ECG to exclude heart diseases, and a pulmonary angiogram to define the presence of blood clots. Potential treatment options include transporting the patient to an emergency room and the use of thrombolytics to improve the circulation of blood. In case of these measures’ ineffectiveness, blood clots should be removed surgically.

Case Study 2

According to the case, a female patient who is twenty-eight years old suffers from asthma but has no specific complaints related to her physical condition. As is clear from the medical history obtained by the specialist, the patient uses necessary drugs to block the symptoms of asthma regularly. The data on this chronic disease is extremely important in the given case. Nowadays, some researchers suppose that abnormal iron levels in adult women are strictly interconnected with asthma and can exacerbate the disease (Brigham, McCormack, Takemoto, & Matsui, 2015).

The patient’s social history indicates that she is quite conscious about her health (the use of tobacco and alcohol is minimized). Despite the absence of clear complaints, some negative findings indicate the need for further research.

The data presented in the case allows making a differential diagnosis. The lab reports presented in the case show that the patient has an insufficient level of hemoglobin. Her hemoglobin is 10 which is low for adult women who are not pregnant. The patient’s hematocrit level is also low. At the same time, the lab reports indicate an increased mean cell volume. All these findings can indicate the presence of macrocytic anemia. The patient history also plays the role in the diagnosis – it is known that this type of anemia can be caused by the regular intake of medications. Physical examination helps to identify many symptoms of this type of anemia such as accelerated heartbeat, decreased appetite, or tiredness.

As for the pathophysiology of macrocytic anemia, it occurs due to the absence of some chemical substances in the human body or affected replication of the DNA. About the most common causes of the condition, this type of anemia is associated with the low levels of B12 and a folate deficiency (Takahashi et al., 2016). Treatment options include the use of special diets and vitamin supplements. The decision concerning the necessity of specialized care should be made based on the presence of dangerous symptoms such as syncopal episodes or bleeding.

References

Brigham, E. P., McCormack, M. C., Takemoto, C. M., & Matsui, E. C. (2015). Iron status is associated with asthma and lung function in US women. PLoS One, 10(2), e0117545.

Haden, M. (2017). Post-operative shortness of breath. Emergency Medicine Journal, 34(5), 330-331.

Takahashi, N., Kameoka, J., Tamai, Y., Murai, K., Honma, R.,… & Ishizawa, K. (2016). Causes of macrocytic anemia among 628 patients: Mean corpuscular volumes of 114 and 130 fL as critical markers for categorization. International Journal of Hematology, 104(3), 344-357.

Tan, S., & Haramati, L. B. (2016). Overdiagnosis versus misdiagnosis of pulmonary embolism. American Journal of Roentgenology, 206(4), W59.

Thromboembolism and Its Prophylaxis Studies

Background

This review includes a brief analysis of the articles by Al-Mugheed and Bayraktar and Popoola et al. in terms of their relation to the formulated PICOT question. Both articles dwell upon venous thromboembolism (VTE) and its prophylaxis, but the studies focus on the perspectives of different stakeholders. Al-Mugheed and Bayraktar explore the knowledge and attitudes of nursing professionals while Popoola et al. examine patients’ perceptions regarding education they receive on VTE prevention. The significance of the research to nursing practice is properly outlined in both articles. Al-Mugheed and Bayraktar state that the incidence of VTE reaches up to 160/100,000, and up to 100,000 patients die of VTE-related issues annually. One of the reasons for the high prevalence of the health issue in question is patients’ low adherence to the guidelines related to VTE prophylaxis provided by the nursing staff (Popoola et al., 2016). Patients have insufficient knowledge regarding VTE, its health outcomes, and prevention.

The primary goal of the study implemented by Popoola et al. is to develop an effective patient training program aimed at raising awareness of VTE and its prophylaxis. Although Popoola et al. do not outline the research questions they addressed, the major question guiding their study can be formulated as follows: What are patients’ preferences regarding VTE-related educational intervention? The purpose of the study by Al-Mugheed and Bayraktar is to explore the awareness of nurses concerning VTE and its prevention and to identify the links between nursing practitioners’ demographic characteristics and their knowledge. Al-Mugheed and Bayraktar put three research questions:

  1. What is the level of nursing professionals’ awareness of VTE, its risk factors, and prevention?
  2. What practices related to VTE prevention do nurses use?
  3. What is the relation between nurses’ descriptive characteristics and VTE-related practices they employ?

The Articles and the Nurse Practice Issue

The chosen articles provide helpful insights into the issue under analysis as they unveil the peculiarities of the attitudes of patients and nurses towards VTE and its prevention. The PICOT question is as follows: Can a one-month educational intervention provided to nurses, as compared to no training, lead to the reduction of the rate of HA-VTE in patients during six months? The data provided by Al-Mugheed and Bayraktar (2018) and Popoola et al. (2016) can be used to develop an effective educational program for nurses who will improve their knowledge of VTE. The intervention will also be instrumental in improving nursing practitioners’ communication skills and help them encourage patients to adhere to the prevention plans developed for them. The two articles target two major groups of stakeholders, which is important for addressing the set PICOT question. The perceptions of patients and nurses should be explored to create an educational program that will be motivational and effective.

Methods

The studies under analysis are based on the use of descriptive research design. The primary data collection tool employed in both cases is the survey that has numerous advantages. LoBiondo-Wood and Haber (2018) note that surveys ensure the collection of a significant bulk of data within a comparatively short period. These instruments are also characterized by clarity and ease of use. However, this method is associated with certain limitations as surveys ensure breadth rather than depth of the findings (LoBiondo-Wood & Haber, 2018). In simple terms, surveys enable researchers to cover quite a large sample, but participants will have a limited number of options to choose from, which may lead to a certain distortion of findings.

Sampling techniques utilize also deserve certain attention as purposeful sampling was employed in both cases. The major benefit of this approach is the opportunity to include people who are knowledgeable and intrinsically motivated to share their attitudes (LoBiondo-Wood & Haber, 2018). At the same time, the generalizability of findings is rather limited as people who remain uncovered within the scope of the study may have different attitudes. Therefore, the findings of both studies should be utilized with a certain consideration, although the most general perceptions of the stakeholders are still given.

Results

As far as the results of the studies under consideration are concerned, Al-Mugheed and Bayraktar report that nurses have sufficient general knowledge regarding VTE. Nurses tend to be aware of the most common symptoms, the processes in the human body that take place, and some prevention strategies. However, their awareness of associated risk factors, prevention, and employed practices is insufficient. Nursing professionals tend to use only a limited set of practices linked to HA-VTE prevention (Al-Mugheed & Bayraktar, 2018). Popoola et al. also utilize surveying and claim that patients prefer being taught on VTE symptoms, major risk factors, and prophylaxis. The patient-doctor format of training delivery is preferable. It is also reported that patients are willing to receive additional materials, including visuals and videos (Popoola et al., 2016). The study shows that people are willing to receive diverse information related to their health.

As mentioned above, the primary contribution of the articles in question is the identification of the existing gaps regarding people’s knowledge on VTE and their attitudes towards different aspects of the disorder prophylaxis. One of the most valuable findings is provided by Al-Mugheed and Bayraktar (2018) who identify the link between nurses’ descriptive characteristics and their knowledge of the disorder under analysis. The researchers also examine the practices nurses use to provide care to patients. It is found that nurses with Bachelor’s degrees or higher and working experience between 6 and 10 years have more comprehensive knowledge and use diverse practices.

Outcomes Comparison

The anticipated outcomes of the PICOT question include the decrease in the rate of HA-VTE incidence and improved skills of nursing professionals after the implementation of the educational intervention. It is expected that an educational intervention will equip nurses with the knowledge and skills necessary to encourage patients to adhere to HA-VTE prevention plans. Al-Mugheed and Bayraktar claim that nurses who have worked for a longer period are more effective when it comes to the provision of training to patients. Therefore, it is possible to expect that on-the-job training will contribute to nurses’ professional development and enable them to employ effective practices.

It is also clear that patients have various gaps in their knowledge regarding HA-VTE, but the study by Popoola et al. unveils the aspects patients are interested in. It can be expected that the inclusion of these concepts will improve patients’ motivation to adhere to prevention plans developed for them. The articles under analysis, as well as the PICOT question, are based on the assumption that continuous education of the nursing staff is beneficial for patients and their health outcomes.

References

Al-Mugheed, K. A., & Bayraktar, N. (2018). Knowledge and practices of nurses on deep vein thrombosis risks and prophylaxis: A descriptive cross-sectional study. Journal of Vascular Nursing, 36(2), 71-80. doi:10.1016/j.jvn.2018.02.001

LoBiondo-Wood, G., & Haber, J. (2018). Nonexperimental designs. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (pp. 180-198). St. Louis, MO: Elsevier Health Sciences.

Popoola, V. O., Lau, B. D., Shihab, H. M., Farrow, N. E., Shaffer, D. L., Hobson, D. B., … Haut, E. R. (2016). Patient preferences for receiving education on venous thromboembolism prevention – a survey of stakeholder organizations. PLOS ONE, 11(3), 1-10. doi:10.1371/journal.pone.0152084

Deep Vein Thrombosis (DVT) Analysis

Introduction

Deep vein thrombosis (DVT) is frequently seen in patients seeking healthcare services in hospitals. DVT can lead to severe morbidity and enhance mortality in the general populace. The incidence of DVT in the United States of America is estimated at about one in every thousand person years. However, reliable incidence data is not truly available as autopsy results often show the presence of DVT, even when there is no clinical suspicion of DVT. So reliance on hospital discharge diagnosis or on death certification hardly provides a true indication of the exact incidence of DVT in any population (Rodriguez & Schwartz, 2003). Such a scenario may have arisen from the impression that superior vein thrombosis (SVT) due to its benign course, often being ignored as a possible sign of DVT. According to the American Public Health Association 2004, DVT and the complications that result from DVT us responsible for as many as 200,000 deaths in the United States of America every year, and many of these deaths could have been prevented. It is the frequent exposure to DVT in the clinical environments die to high incidence of DVT and the high morbidity and mortality associated with DVT that has evoked interest in DVT and the reason for this paper.

Predisposition to DVT

Since the beginning of the twentieth century three factors were considered as being responsible for the predisposition of an individual for DVT. These three factors were a high state of coagulability, trauma to the vascular intima, and venous stasis. Evidence from over these hundred years suggests that such a consideration of the predisposition of an individual to DVT was true, as the currently held predisposition factors show. The current understanding of CVT shows that several factors influence the predisposition to DVT, which are a combination of genetic risk factors and acquired conditions. Estimates suggest that genetic causes are responsible for 25% of the cases of DVT, and where there is a family history DVT this percentage increases to 63% clearly indicating genetic factor responsibility. The elevated levels of factor VIII5 and high plasma homocysteine levels are important among the factors considered to be responsible for DVT. Among the acquired predisposition factors for DVT stasis is the most frequently encountered precipitating factor. Enhanced age, obesity and restriction to movement, smoking and prolonged travel aggravate any of the acquired predisposition factors (Rodriguez & Schwartz, 2003).

Surgical interventions are found to be responsible for the final precipitating factor of vascular injury leading to DVT. There is general acceptance that orthopedic surgery has a very high risk potential for postoperative venous thromboembolism. The high potential or venous thromboembolism (VTE) has many factors that contribute to it. Injury to the blood vessels is one factor. The second factor is venous stasis of the legs and arms. The third factor is advance in age and the reduction in mobility (Rodriguez & Schwartz, 2003).

Pathophysiology of DVT

In the opinion of James, Ortel, and Tapson 2008, p.6 the pathophysiology of DVT can be defined as “the formation of a blood clot in one of the deep veins of the body, usually a vein in the muscle of one of the legs” (James, Ortel & Tapson, 2008).

There are two forms of DVT namely non-occlusive thrombosis and occlusive thrombosis. In non-occlusive thrombosis blood flow in the vein is not fully blocked, whereas in the case of occlusive thrombosis the blood flow in the vein is fully blocked. Evidence from studies are demonstrative of the figures that in 77% of the cases DVT occurred in one leg, while in 12% of the cases DVT occurred in both legs, and in about 11% of the cases the occurrence of DVT was in the arms. This shows that the occurrence of DVT is essentially confined to the legs and arms with rare episodes of DVT in other parts of the body like brain, neck, liver, pelvis, and inferior vena cava (James, Ortel & Tapson, 2008).

The hypercoagability state associated with DVT is the consequence of the disruption of the normal balance that exists in relation to the procoagulant system and the anticoagulant system in the human body. In normal body function the anticoagulant system attempt is to confine the beneficial thrombotic effect to the site of injury and thereby prevent its propagation. The factors associated with this anticoagulant system are tithrombin III, Protein C, and Protein S. Protein starts acting as a response to the activation of enzyme APC, which performs the function of a natural anticoagulant through the inactivation of the procoagulant factors Va and VIIIa, when protein S is present. Antithrombin III has the action of directly of directly inhibiting thrombin. Mutation of the Factor V Leiden can inhibit the normal functioning of the anticoagulant system of the human body. In addition the normal functioning of the anticoagulant system of the human body can be negatively affected by deficiencies in the availability of Protein C, Protein S, and antithrombin. The high plasma levels of prothrombin 20210A and factor VIII have the action of accelerating the working of the procoagulant system and enhancing the risk for DVT. Research in molecular genetics is trying to uncover other prothrombotic mutations that are responsible for enhanced risk for DVT (Rodriguez & Schwartz, 2003).

Evidence from studies has clearly demonstrated that normally DVT develops in the veins of the calf muscles of the legs and then progress proximally. Though there is less clarity on the development of DVT in pregnant women, there are indications that proximal deep vein thromboses, with particular emphasis on iliofemoral are frequently seen in pregnant women and the anatomic distribution of these thromboses vary significantly from women who are not pregnant, suggesting that it would be useful to examine the iliofemoral venous system, when there is suspicion of DVT in pregnant women (Wee-Shian et al, 2010). Variance of the development of DVT in pregnant women from that of non-pregnant women receives support from Risto 2010, who further suggests that in pregnant women there is no usual route for the development of DVT. In pregnant women the development of thrombosis and its propagation are seen to be different on the basis of the various risk factors pertinent to the case of each pregnant woman the thrombosis and propagation can be different based on the risk factors of thrombophilic status. These risk factors include the affect that the growing uterus has on the possibility of venous stasis of the lower extremities and the requirement for immobilization during pregnancy (Risto, 2010).

Complications with DVT

The blood clot responsible for DVT can break away from the site of DVT and move along to other parts of the body causing serious complications in other parts of the body. This clot can travel along the blood vessels and makes its presence felt in the lung artery as pulmonary embolism (PE). PE is a major complication with DVT that can have serious consequences including death of the patient. PE remains the most significant complication that leads to death in patients with DVT. Postthrombotic syndrome (PS) is a more common complication associated with DVT, with as many as two thirds of patients with DVT landing up with PS. The continuing presence of a blood clot for long periods of time in the veins of the lower extremities can damage the valves of the veins. As a consequence blood can flow back the blood due to the action of gravity. Reflux in the vein can result in blood pooling in the leg, which can cause pain in the leg, swelling of the leg, darkened skin color, skin ulcers, varicose veins, recurrent deep vein thrombosis, PE. The more rare risks associated with DVT include blood clot in the kidney or renal vein thrombosis, thrombosis in the heart that can cause heart attacks, and blood clot in the brain and the resultant stroke (Bryg, 2009).

Treating DVT

There are four objectives associated with the treatment of DVT. These objectives are prevention of mortality from pulmonary embolism; alleviation of the common symptoms of pain and swelling associated with DVT; preventing morbidity of the patient as a result of recurrent DVT or PE; and preventing post-thrombotic syndrome in the patient and making the post-thrombotic symptoms as minimal as possible (Raskob, 2009).

In most patients these objectives are met by the pharmacological intervention of anti-coagulant therapy consisting of heparin as initial treatment and long term treatment extending to six months (Raskob, 2009). Initial treatment using oral anticoagulant therapy is insufficient. The recommended start to the treatment of DVT is the appropriate doses of unfractionated heparin or LMW heparin. LMW heparin is easy to administer and so remains the choice in anticoagulant therapy in clinical or home settings. LMW heparin is effective as lesser mortality, reduction in major hemorrhage and recurrence has been reported through its use. Another useful alternate pharmacological agent is fondaparinux, which is effective and also provides the advantage of absence of heparin induced thrombocytopenia (Dimitrios & Wells, 2006).

Non-pharmacological interventions can be used to reduce the swelling and pain associated with DVT. The non-pharmacological intervention involves ambulance along with compression of the leg in medically patients with DVT. Evidence from randomised controlled studies has shown that the combination of compression and ambulation reduces thrombus progression, pain, and swelling (Dimitrios & Wells, 2006).

Rationale for a Health Care Team in DVT

The management of DVT involves different disciplines involved in providing the required service. No single discipline is capable of providing all the DVT management services required. The management involves different treatment modalities that consist of pharmacological treatments extending to surgical interventions. The complications that can arise from DVT could implicate several vital organs of the body requiring specialist attention. Non-pharmacological interventions are involved once the patient has been stabilised. These factors contribute to the requirement of a health care team consisting of medical, surgical and specialist clinicians, pharmacists, physiotherapists and last but nit the least nursing professionals (Robinson, 2006).

Role of the Nursing Professional in the Healthcare Team

The management of DVT involves procedures, diagnostic tests, therapies, treatments, and medications. The nursing professional will have to plan and schedule all these activities involving the patient. This would call for the development of organizing skills and resourcefulness on the part of the nursing professional. Several procedures, treatments and therapies are involved and there is the need for evaluation of the interventions in meeting the outcome objectives for the concerned patient. The nursing professional plays a key role in this evaluation and also in patient satisfaction. These activities need to be coordinated and monitored, which requires good verbal and written communication skills. Ensuring that appropriate communication to the other members of the team is maintained in keeping with the quality standards in meeting patient care needs is a part of the role of the nurse. Finally monitoring all these activities requires maintaining records in a user friendly manner that can be accessed and seen by the other members of the team (Daniels, 2004).

Conclusion

There is a high incidence of DVT in the United States of America. Complications arising from DVT are the cause of many deaths. Many of these complications of DVT can be prevented. These factors make it necessary for healthcare professionals to be aware of the risks factors of DVT, its development in the body, the progress of DVT in the human body, the complications that arise from it, and the treatment and prevention modalities. The care needs of patients with DVT are such that it cannot be managed by any single discipline that provides health care needs. As a result care needs of a patient with DVT are provided by a healthcare team. The nursing professional plays a pivotal role in ensuring the quality of care provided by the healthcare team.

Literary References

American Health Association. (2004). March Is Deep-Vein Thrombosis Awareness Month. Web.

Bryg, R. J. (2009). Complications of Deep Vein Thrombosis (DVT). Web.

Daniels, R. (2004). Nursing Fundamentals: Caring & Clinical Decision Making. New York: Delmar Learning.

Dimitrios, S. & Wells, P. S. (2006). Diagnosis and treatment of deep-vein thrombosis. CMAJ: Canadian Medical Association Journal, 1087(6), 175-179.

James, A. H., Ortel, T. L. & Tapson, V. F. (2008). 100 Questions &Answers About Deep Vein Thrombosis and Pulmonary Embolism. Sudbury, MA: Jones and Bartlett Publishers.

Raskob, G. (2004). Initial and Long-Term Treatment of Deep Vein Thrombosis. In Edwin, J. R. Van Beek, Harry R. Buller & Oudkerk, Mathijs (Eds.) Deep Vein Thrombosis and Pulmonary Embolism (pp. 475-486), Oxford: John Wiley & Sons.

Risto, K. (2010). Is deep vein thrombosis different during pregnancy? CMAJ: Canadian Medical Association Journal, 649(2), 182-187.

Robinson, L. R. (2006). Trauma Rehabilitation. Philadelphia, PA: Lippincott, Williams & Wilkins.

Rodriguez, G. S. & Schwartz, T. M. (2003). Venous Thromboembolism. In Robert B. Taylor (Ed.) Family Medicine: Principles and Practice. Sixth Edition (pp.693-698). New York: Springer Verlag.

Wee-Shian, C. (2010).. Anatomic distribution of deep vein thrombosis in pregnancy. CMAJ: Canadian Medical Association Journal, 657(4), 182-187.

The Thrombosis of the Femoral Vein

Etiology of the lesion

The thrombosis of the femoral vein is one of the deep vein thromboses that make up the major grounds that result in cardiovascular deaths. The incidences of deaths resulting from the femoral thrombosis have increased in the recent years and are prevalent among the middle-age population (Manly 517). The average age of most of the patients diagnosed with femoral vein thrombosis ranges between 43-48 years. The average deaths caused by the femoral thrombosis ranges between three thousand and three hundred and fifty thousand worldwide. As a result, there is increasing concerns to increase the life expectancy as well as strategies for prevention and treatment.

Like any other Deep vein thrombosis, femoral thrombosis is caused by endothelial disruptions. Endothelial disruptions are internal mechanisms that are taking place without any injuries to the vein. There are activities that are associated with increased risk of developing femoral thrombosis including immobilization, persistent venous deficiency and pregnancy. These body mechanisms prevent the normal venous blood flow (Heit 371).

Macroscopic and microscopic findings

An evaluation of venous thrombi in a controlled study using specimen creatures after a definite time clearly indicate the macroscopic differences between sections with red together with white thrombus. Using the van Gieson (Vg) to stain the specimen, it can easily be identified through microscopic scanning the femoral thrombin. Van Gieson (Vg) stain makes it easier to identify white as well as red film with rich erythrocyte (Manly 517).

However, the stain must be given some time approximately 48 hours to attain the results. After 48-hour initiation of DVT, it can clearly be observed that there is a clear difference in the segments portraying red as well as white thrombus blot. Further, to exhibit the coatings resulting from the cells responsible for the defense mechanism of the body as well as the fluid content of the body together with the fibrin, carstairs staining (CS) is applied on the specimen. In addition, to have microscopic observations the circulation of platelets in groups, a DAPI staining is applied (Heit 370).

The microscopic and macroscopic experiments indicate that there is a correlation between the venous inflammation and femoral malfunctions. However, there exist no precise functions of the immune cells in the development of femoral thrombosis. In addition, the results from the experiments indicate that the major constitution of the cells within the femoral inflammation is mainly leukocytes. The leukocytes are distributed in layers crowded together contiguous to the integral endothelium. Further, neutrophils, which is a subdivision of leukocytes is predominantly present in the venous thrombi. Monocytes were also found to be occupying the remaining part. Another critical observation is that there is an implicit absence of lymphocytes.

Symptoms, signs, and laboratory findings caused by the lesion

The signs and symptoms that are associated with femoral thrombosis are numerous. The most specific being the situation characterized by the swelling of hands, legs as well as ankles. The sign is as result of unusual accretion of interstitial fluids that are retained in the tissues. The situation is referred to as edema (Mackman 916). The symptom is common to a large number of patients likely to show characteristics of femoral thrombosis. In addition, the patients also experience pulmonary embolism characterized by impasse through lung arteries. As a result, blood clots occur in the patient legs. Further, a number of affected patients experience pains around the area affected by thrombosis.

Moreover, there is an experience of warmth accompanied by rashes and the change of skin color to reddish due to clogging of the blood passages over the areas of femoral vein. In addition, there is a feeling of softness of the skin that is being experienced by over three quarters of the patients with femoral thrombosis (Heit 370). Additionally, physical findings comprise pain experienced on the bent foot as well as tender subcutaneous capillaries sections. Further, the retention of accumulated interstitial fluids in the body tissues causes pale looks on the leg. The patients also experience inconsistent staining of their lower edges.

Treatment and prognosis

The development of suggestions by the physicians in trying to treat the potential patients showing signs of femoral thrombosis comprise the application of legitimate regulations used in clinical forecasts (Mackman 916). For instance, the application of Wells enable the physicians in coming up with precise explanations from the results achieved in pretesting the probability venous thromboembolism. Additionally, the selecting patients with low pre-examination likelihood of femoral thrombi are critical in obtaining high sensitive D-dimer. Further, the application of ultrasonography is very significant for patients with high pretest likelihood as far as femoral thrombi are concerned.

Moreover, studies based on image diagnostics such as pulmonary angiography and ventilation-perfusion scan play a very significant role in the treatment and diagnosis of femoral thrombosis (Mackman 916). In addition, the application of multi-detector helical CT is a necessary requirement in the diagnosis of femoral thrombosis. Further, in the treatment of femoral thrombosis, laboratory experiments have advanced a number of tests such as D-dimer test. In addition, in order to assess the hypercoagulable conditions of stimulated fractional thromboplastin period together with the original time of prothrombin, coagulation experiments have been undertaken.

Several alternatives have been developed for the healing of the femoral thrombosis including the application of pharmacologic thrombolysis as well as surgical and endovascular intercessions. Moreover, physical actions including ambulation are very vital in the treatment of femoral thrombosis. In addition, the use of flexible compression stockings is also a vital option in treating femoral thrombosis. Further, treatment of thrombosis is also possible with anticoagulants such as heparins that produce unfractionated heparin as well as low-molecular weight heparin. In addition, factor Xa inhibitors that include rivaroxaban and fondaparinux are very essential in the reduction of bleeding.

In a bid to reduce the probability of thrombosis intermittent as well as diminish the harshness together with the period of lower extremity signs, a great emphasis is put on executing endovascular psychoanalysis, which is very essential (Esmon 226). As such, percutaneous transcatheter treatments that include mechanical thrombectomy, angioplasty as well as venous barrier stenting are fundamental. In addition, catheter-directed thrombolysis that gets rid of thrombus especially for patients suffering from huge iliofemoral vein thrombosis is a vital treatment mechanism of femoral thrombosis. Further, interior vena cava filter is also vital in treatment of femoral thrombosis.

Relevance to dental practice

Oral health cannot be separated from the general well being of the individuals. There are connections between the oral and other systematic diseases. Therefore, understanding the systematic diseases helps in the conceptualization of the dental care (Patton 520). In particular, understanding the treatment, signs and symptoms as well as other processes involved in femoral thrombosis are critical in the understanding of how some dental diseases could be treated. The processes in the treatment of femoral thrombosis such as surgery are also used in the treatment of some dental diseases. Therefore, understanding the processes involved in the treatment of femoral thrombosis is helpful in the dental care.

Works Cited

Esmon, Charles. “Basic mechanisms and pathogenesis of venous thrombosis.” Blood Review, 23.4 (2009): 225–229. Print.

Heit, John. “The epidemiology of venous thromboembolism in the community.” Journal of Arteriosclerosis Thrombosis and Vascular Biology, 28.6 (2008): 370–372. Print.

Mackman, Nigel. “Triggers, targets and treatments for thrombosis.” Journal of Natural Medicine, 451.11 (2008): 914–918. Print.

Manly, David. “Role of tissue factor in venous thrombosis.” Annual Review of Physiology, 73.16 (2011): 515–525. Print.

Patton, Lauren.The Complexity of the Periodontal Disease – Atherosclerotic Vascular Disease Relationship and Opportunities for Inter-professional Collaboration.” Journal of Medical Research, 16.2 (2012): 519-556. Print.

The Diagnosis of Heparin-Induced Thrombocytopenia

The article covers a study conducted to determine the effectiveness of using laboratory and clinical data in the diagnosis of heparin-induced thrombocytopenia (HIT). According to the authors, HIT is a serious complication that can be caused by the use of products that contain a polysaccharide referred to as heparin. The most serious type of HIT is immune-mediate HIT that results from a negative immune response that leads to formation of antibodies against the presence of heparin in the blood. The prevalence of thrombocytopenia is enhanced by risk factors that include type of clinical settings, exposure to heparin, and decline in the number of platelets in the body. The article states that early management and diagnosis is important in order to lower the risk to thrombotic events. Currently, HIT is diagnosed through analysis of data collected in clinic and laboratory environments.

In clinical settings, examples of tests used t generate data include anti-PF4 assay and the serotonin release assay (SRA). The 4T’s pretest probability score is atoll used in clinical settings to determine the likelihood of a patient developing HIT based on three critical risk factors. The main objective of the study was to evaluate the usefulness of using 4T’s scores and anti-PF4 OD values obtained from enzyme-linked immunosorbent assay (ELISA) test to enhance the diagnosis of HIT. The study involved a thorough evaluation of 156 clinical cases involving patients with high HIT diagnosis scores. The results of the study revealed that 4T’s score was a more effective tool for early diagnosis of HIT than the atnti-PF4 assay test. The combination of both anti-PF4 OD values and $T’s scores were effective in enhancing the diagnosis of HIT. In that regard, combination of both tools eradicates the need to use SRA in diagnosis of HIT especially among patients with low scores obtained from both diagnostic tools.

Type of article

The article is a quantitative research study that involved evaluation of data collected from different patients. Data analysis was done using STATA. The article was relatively difficult to read because of extensive use of complex medical terminologies. Other than that, the authors use simple language to discuss the rationale of the study as well as the methodology and results. Certain parts of the article were easy to read because of the inclusion of a summary that presents the purpose of the study, methodology, results obtained, and the conclusion. The article’s target audience is medical practitioners and people at risk of HIT as well as people suffering from HIT. The information it contains can be useful in the diagnosis and management of HITs.

Things learned from the article

I have learned several things from reading the article. First, there are two types of HIT and the most severe type is the one caused by the production of antigens by the immune system in response to the [presence of heparin in the body. Second, I have learned that diagnosis of HIT involves analysis of both clinical and laboratory data. Third, I have learned about a clinical tool (4T’s pretest probability score) and laboratory tests (anti-PF4 assay and serotonin release assay) used to diagnose HIT. Fourth I have learned that the combination of anti-PF4 and 4T’s scores can be used to accurately confirm the presence of HIT in a patient without using SAR. The results of the study can be used by clinical practitioners to reduce deaths associated with HIT by conducting prompt confirmation of immune –mediated HIT and applying relevant treatment remedies.

In addition, nurses can use a combination of both clinical probability scores and laboratory values to overcome the limitations of diagnostic methods that are currently used. The information is evidence-based because it was generated from a sound research study and not opinion. The study involved analysis of clinical results obtained from 156 patients. In addition, the blood samples collected from all patients were analyzed in a reference laboratory to ensure that the patients had HIT. Each of the 156 cases was scored for probability of HIT. Moreover, a multiple regression model was used to evaluate the combined efficacy of clinical scores and laboratory values in predicting SAR results. He information is academic, evidence-based, and therefore, valuable in clinical practice. The article ignited in me the curiosity to know more about it because it was very insightful and the authors cited several limitations that could have affected the quality of the study as well as the findings.

Conclusion

HIT is a serious complication that can result in death if it is not diagnosed early. Proper and early diagnosis is important for its effective management. The results of the article contain useful information that can be applied in clinical practice for early diagnosis of HIT. As the article revealed, combining both anti-PF4 OD values and 4T’s scores can be used to diagnose HIT early and overcome the limitations of diagnosis methods that are currently used. The article contains insightful information that can be used in clinical practice.

Heparin-Induced Thrombocytopenia

The article by Frazer (2013) is related to the condition known as heparin-induced thrombocytopenia (HIT), which is an autoimmune reaction causing a dearth of platelets (=thrombocytes) in an individual’s blood due to the use of the drug heparin. The article briefly presents a case in which a patient was suspected of having HIT after the administration of heparin. The author then provides some information on HIT, writing about the following: when HIT may take place, factors that predispose HIT occurrence, similar drugs which may also be related to this condition, diagnosing HIT in patients, the thrombosis as the most common complication of HIT, and HIT management. The article also includes three questions pertaining to the topic, together with the answer key and the rationale for the answers (Frazer, 2013).

The Type of Article

The article includes a succinct summary of a case, thus including a case study. On the whole, however, the work by Frazer (2013) is an educational article that provides general information about HIT.

The Target Audience

The target audience of the article by Frazer (2013) is, clearly, nursing students who need to learn more about HIT. The article, however, can be used by any individuals who need to advance their knowledge of medicine, for instance, by younger students of medicine. Still, the article is written primarily for nursing students, for it is published in a journal for nurses and provides the data that is most essential for nurses (without, for instance, going into details pertaining to the molecular mechanism using which the heparin affects a patient’s condition).

Is the Article Easy to Read?

To the author of the current paper, the article by Frazer (2013) was rather easy to read. This is due to the fact that the text is written in quite a simple language, is not overloaded with terms the understanding of which requires advanced knowledge e.g. in molecular biology, and describes HIT and the most important issues related to it in a simple yet effective manner.

What Was Learned from the Article?

The author of this paper already had had some basic knowledge pertaining to HIT, but the article by Frazer (2013) provided some additional insights into this medical condition. For instance, it was learned that HIT should be suspected in patients who were previously administered heparin in cases when the thrombocytes count is 30-50% decreased from the values obtained before administering the drug, even if these values are within the normal platelet count range (which is 150,000-450,000 thrombocytes for every microliter of blood) (Frazer, 2013). The new information also included the fact that testing for antibodies may serve as an additional confirmation of HIT, but that there are many patients whose blood tests are positive for HIT antibodies even when these patients are not suffering from clinical HIT (Frazer, 2013). After reading the article, it also became known to the author of this paper that the thrombocytopenia caused by heparin is only moderate in most cases, and that the thrombocyte count very seldom falls to values lower than 20,000 platelets per a microliter of blood (Frazer, 2013).

How the Information Can Be Used in Clinical Practice

The data supplied by Frazer (2013) can easily be utilized in clinical practice. For instance, the above-mentioned fact about the levels of platelet count which should be a cause for HIT suspicion can prove very useful while monitoring the patients’ blood tests. The information pertaining to the factors that predispose individuals to HIT will also be of use, for the presence of these factors will mean that platelet count will need to be more closely monitored. The fact that HIT may be complicated by thrombosis is also paramount, for it significantly affects the treatment and makes the nurse aware that the patient taking heparin should also be monitored for the symptoms and signs of thrombosis – such as unilateral calf swelling, which may occur due to deep vein thrombosis (Frazer, 2013).

Is the Article Evidence-Based?

The work by Frazer (2013) is evidence-based. This is clear from the use of in-text referencing in the places where the information is not limited to the general observations pertaining to the topic. For instance, the statement about the thrombosis being one of the most common complications of HIT that may occur before the number of thrombocytes falls is referenced, and this statement was taken from an academic source; and at least some of the sources cited in Frazer (2013) are peer-reviewed journal articles.

Does the Article Leave the Reader Wanting to Know More?

The article provides basic information about the subject that may be sufficient for a beginning nursing student. However, it also mentions a number of phenomena which it would be interesting to learn more about. For instance, it is mentioned that women are at a higher risk of having HIT (Frazer, 2013), and it is not explained why, so a reader might be curious to find it out. Another example: the question #2 asks about symptoms or signs which might indicate HIT (Frazer, 2013); it may stimulate the reader to think more about the symptoms or signs which might appear as a result of HIT.

Conclusion

Therefore, it should be stressed that the article by Frazer (2013) supplied an overview of HIT, offering some basic but important information about it, and demonstrated an example of HIT by providing a brief summary of a case. The author of this paper learned some facts about HIT, such as when HIT should be suspected, which tests could help detect it, and how serious the dearth of platelets in patients with HIT usually is. The article also proposed some insights that might be used in the future clinical practice by the author of this paper.

Reference

Frazer, C. A. (2013). Heparin-induced thrombocytopenia. MEDSURG Nursing, 22(6), 397, 399.

Heparins and Heparin-Induced Thrombocytopenia

Nowadays, there are many ways to be used to prevent deep vein thrombosis and the development of pulmonary embolism. Heparin is one of the well-known blood thinners that could be used to treat problems with blood and myocardial infarctions. Though heparin is not actually an anticoagulant, it performs the function of a catalyst in plasma antithrombin III (Little, Falace, Miller, & Rhodus, 2012). It is important to know its pathophysiology and recognize its forms to make the correct choice.

Pathophysiology of Heparin

The peculiar feature of heparin is that it has to be taken parentally only because of its inability to be absorbed through the gut. It could be injected under skin frequently because it has a short biologic life. Therefore, it is necessary to give enough Heparin that may include 1400 units/h (DeLoughery, 2014). In the body, heparin is used to make anti-thrombin (AT), a serine protease inhibitor, a better inhibitor for proteases that are activated by each other in the coagulation cascades (Hoffman, 2010). Negatively charged molecules of heparin are bound with positively charged molecules of AT. This connection causes changes that result in the inactivation of thrombin. Heparin-induced thrombocytopenia (HIT) is one of the most serious side-effects of heparin observed in people. HIT pathophysiology is dynamic and complex because it depends on the way of how activated platelets, coagulation proteins, and monocytes behave (McKenzie & Sachais, 2014). The formation of an immune complex occurs that could be recognized as a foreign substance in the organism and the necessity to form an antibody against it. As soon as the antibody is formulated, it destroys platelets and promotes thrombocytopenia.

Common Conditions of Heparin

Stroke

In many hospitals, heparin is used intravenously in order to reduce stroke damage or stroke risks that are usually connected with the formation of thrombus in leg veins and artery blockage in lungs. Strokes are directly associated with the creation of blood clots. It is necessary to scan the brain of a stroke patient and clarify if there are the cases of bleeding. If no bleeding is discovered, heparin could be offered. However, heparin may not dissolve the already present blood clots but just prevent their growth and reduce the possibility of stroke. At the same time, heparin could be the reason for another stroke in case bleeding begins.

Blood Clots

The analysis of heparin proves that this medication helps to prevent the formation of new blood clots and the growth of the already existing clots in the blood. Heparin has a possibility to inactivate thrombin and prevent the creation of fibrin clots. It should be slowly injected into a vein, never in muscle, six or even more times per day. Much attention should be paid to the use of heparin in mesenteric ischemia and the creation of an embolus that usually occurs in the superior mesenteric artery (SMA). It is necessary to remove the embolus in a short period of time and reduce the possibility of its development, heparin could be used through a catheter that is placed in the SMA.

Work of Heparin in the Drip Form

Heparin drip is usually prescribed after surgeries in order to avoid the possibility of stroke risks and thrombosis. The drip form helps to avoid unexpected outcomes and achieve the required results with ease reverse and absent renal dosing.

References

DeLoughery, T.G. (2014). Heparins and heparin-induced thrombocytopenia. In T.G. DeLoughery (Ed.), Hemostasis and thrombosis (pp. 111-116). New York, NY: Springer.

Hoffman, M. (2010). Heparins: Clinical use and laboratory monitoring. Laboratory Medicine, 41(10), 621-626.

Little, J.W., Falance, D., Miller, C., & Rhodus, N.L. (2012). Dental management of the medically compromised patient. St. Louis, MO: Elsevier Health Sciences.

McKenzie, S., & Sachais, B.S. (2014). Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia. Current Opinion in Hematology, 21(5), 380-387.