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Lower Limb Trauma
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Initial BOAST management is often carried out by the T&O team but for safety, ensure the following steps have been completed:Prophylactic IV antibiotics as per trust protocol have been given within 1 hour of the injury (BOAST guideline).Tetanus shot given/up to date with tetanus (BOAST guideline).Prophylactic dose low-molecular-weight heparin prescribed.Secondary survey completed.Appropriate analgesia and fluid resuscitation of patient given.Two orthogonal view X-rays of fracture site including joint above and below.
Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
As noted earlier, patients with COVID-19 have been shown to be at risk for thromboembolic events. Pregnancy is a pro-thrombotic state. However, no high-quality studies have examined thromboprophylaxis in pregnancy with COVID-19. Thromboprophylaxis should be initiated for the same reasons as non-pregnant patients admitted to the hospital. Antithrombotic therapy started for other indications should be continued if diagnosed with COVID-19. Routine anticoagulation is not recommended but may be considered for patients at high risk of venous thromboembolic events or are critically ill. Low-molecular weight heparin is preferred in pregnancy.
Vascular Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Consideration should be given to postoperative anticoagulation and the decision must be documented. A heparin infusion is often the most appropriate form of initial anticoagulation as this can be easily reversed; however, it requires frequent and repeated monitoring of the APTT and patients on heparin infusions are frequently outside the therapeutic range. Low-molecular weight heparin is a more convenient method of anticoagulation in patients at low risk of bleeding. The final task is to plan what to do in the event of failure of the vascular repair based on the operative findings and difficulty of the procedure—should the repair be re-explored, or would a damage control option such as ligation or amputation be more appropriate?
Fatal cerebral hemorrhage in a patient with thrombotic thrombocytopenic purpura with a normal platelet count during treatment with caplacizumab
Published in Platelets, 2022
Kim Ditzel, Dirk Jan Mons, Rob Fijnheer
A 50 year old patient was referred to our hospital for treatment with caplacizumab. Her medical history includes an episode of aTTP in 2006 and rheumatoid arthritis. She was currently admitted with a relapse aTTP, which was progressive under treatment with corticosteroids, plasmapheresis and rituximab. ADAMTS13 was 1% at presentation. At this point, the patient manifested with a light altered consciousness, a deep venous thrombosis of the left common iliac vein and a progressive hemolytic anemia and thrombocytopenia. After 10 days of treatment with steroids, plasmapheresis and one dose of rituximab, her laboratory findings showed a hemoglobin of 5.5 mmol/L and a platelet count of 9 x10^9/L. She was admitted to our hospital and we added caplacizumab to her treatment. She received the first dose intravenously prior to plasmapheresis, after which she received a dosage subcutaneously after every plasmapheresis. Low molecular weight heparin was given at admission in a prophylactic dosage in order to prevent progressive deep venous thrombosis.
Massive postpartum pulmonary embolism successfully treated with v-a-v ECMO: a case report
Published in Journal of Obstetrics and Gynaecology, 2021
Greta Balciuniene, Lukas Balciunas, Lina Jakubauskiene, Diana Ramasauskaite, Mindaugas Serpytis, Lina Gumbiene, Jurate Dementaviciene
On the tenth day, ECMO arterial cannula was removed following one day with veno-venous ECMO system. Anticoagulation was switched to therapeutic doses of low-molecular-weight heparin. For the rest of the ICU stay patient had sensorimotor aphasia with the Glasgow Coma Score of 12 (E-4, V-2, M-5). Changes on computer tomography (CT) and magnetic resonance imaging (MRI) showed regions of edema, in watershed zones involving white and grey matter with small haemorrhages, variable contrast enhancement and with slight diffusion restriction, with no arterial or venous occlusions on CT angiography were concluded as posterior reversible encephalopathy syndrome (PRES). On the 27th day of hospitalization, patient was transferred to the Intensive Care Unit of the regional hospital, she became fully cooperative on day 40.
Risk assessment of venous thromboembolism in hematological cancer patients: a review
Published in Expert Review of Hematology, 2020
Thomas Sau-Yan Chan, Yu Yan Hwang, Eric Tse
In myeloma, the use of aspirin has been shown to be effective in the prevention of VTE in IMiDs-treated patients [98,99], bringing down the overall incidence to less than 5%. The use of low molecular weight heparin is theoretically more effective. However, data have been conflicting. In two randomized phase III trials evaluating the effectiveness of aspirin and low molecular weight heparin as thromboprophylaxis [100,101], there was no significant difference between the two groups. Therefore, in the absence of other risk factors, the use of aspirin alone is recommended. However, if the use of IMiDs is coupled with high dose steroid (dexamethasone of more than 480 mg/month) or multi-agent chemotherapy, or if the patient has other general risk factors for VTE (e.g. obesity, reduced mobility, or personal risk factor of VTE), the use of vitamin K antagonist or LMWH is advocated. These recommendations were again consistent across major guidelines (NCCN [93], ASCO [9], and IMWG [102])