Venous Thromboembolism in Pregnancy
Sanjeewa Padumadasa, Malik Goonewardene in Obstetric Emergencies, 2021
The aims of anticoagulant therapy are to prevent the clot from propagating and to prevent the formation of new clots. When there is a high suspicion of VTE, anticoagulant treatment should be commenced, unless there is a strong contraindication to its use, and continued for one week. This must be done even if the initial duplex ultrasound and V/Q scan or CTPA are negative, at which point PE should definitely be excluded by appropriate investigations. When there is low suspicion of DVT but no suspicion of PE, anticoagulant therapy can be discontinued if the duplex ultrasound is negative. However, duplex ultrasound should be repeated on days 3 and 7 if clinical suspicion of DVT remains high. Anticoagulant treatment should be recommenced if the repeat duplex ultrasound confirms the diagnosis of DVT.
The heart
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
The congestive effects of cardiomyopathy on the pulmonary and systemic circulation may be relieved somewhat by the use of diuretic drugs and with salt and water restriction. Bed rest can reduce workload on the heart, as can vasodilator drugs that cause venous and arterial dilation. Positive inotropes such as digitalis glycosides may be used in dilated cardiomyopathy to enhance contractile function of the heart muscle. Anticoagulant drugs can also be employed to prevent blood clots from forming in pooled blood. In hypertrophic cardiomyopathy, β blockers may be useful to slow heart rate and allow the ventricles a greater time for filling. Prevention of arrhythmias is also important in hypertrophic cardiomyopathy. Surgical removal of a portion of the hypertrophic ventricles may also be carried out to improve overall cardiac function.
Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
Wenguang Xia, Xiaolin Huang in Rehabilitation from COVID-19, 2021
If it is diagnosed as DTV, treat according to the following principles. General treatment: The affected limb is raised, and the movement should be reduced. After the swelling of the affected limb gradually subsides after 2 weeks, the patient should wear elastic stockings to relieve symptoms.Drug treatment: When the risk of bleeding is assessed as low at acute stage (within 2 weeks of onset), anticoagulant therapy is given; anticoagulant therapy for 3 months is appropriate for patients without persistent VTE progression factors. Patients can directly take anticoagulant drugs (argatroban, dabigatran, rivaroxaban, etc.), low molecular weight heparin, and warfarin. Contraindications in drug use should be noted. The preferred dose of anticoagulant may be, for example, rivaroxaban 20 mg orally, once a day; 1 low-molecular-weight heparin, subcutaneously injected once every 12 hours; the initial dose of warfarin is 1 tablet orally, and the International Normalized Ratio (INR) is tested to maintain the INR 2.0–3.0.
Macrophage activation syndrome in systemic juvenile idiopathic arthritis
Published in Immunological Medicine, 2021
Masaki Shimizu
The intravenous infusion of a high-dose glucocorticoid is the basic treatment for MAS. Methylprednisolone pulse therapy (30 mg/kg/time, 3 days as one course, one to two courses) is widely used as a first-line treatment. The intravenous infusion of dexamethasone palmitate (2.5–5.0 mg, every 12 h; half a dose for infants) also is effective. In addition, cyclosporine to suppress T cell activation and restrain mitochondrial permeability conversion by TNF-α is used widely (continuous intravenous infusion, 1–1.5 mg/kg/day) [66,67]. However, patients treated with corticosteroids and cyclosporine are at high risk for developing posterior reversible encephalopathy syndrome [68,69]; therefore, tightly controlling patient blood pressure is essential. In addition, anticoagulant therapy is needed. Apheresis therapy, including plasma exchange and leukocytapheresis, has been performed in refractory cases to corticosteroids and cyclosporine [70–72].
Pharmacokinetics of anticoagulants apixaban, dabigatran, edoxaban and rivaroxaban in elderly Japanese patients with atrial fibrillation treated in one general hospital
Published in Xenobiotica, 2019
Miho Yamazaki-Nishioka, Minoru Kogiku, Masayuki Noda, Sumio Endo, Mitsuru Takekawa, Hirohisa Kishi, Miki Ota, Yuki Notsu, Makiko Shimizu, Hiroshi Yamazaki
Anticoagulant therapy is commonly used for the prevention and treatment of venous thromboembolism and the prevention of stroke in patients with atrial fibrillation (Rose & Bar, 2018). The basis of thrombosis treatment is anticoagulation. Anticoagulants are drugs that prevent and treat blood clots and reduce the risk of blood clots breaking off and travelling to vital organs. Different types of oral anticoagulants are widely used clinically (Adcock & Gosselin, 2015): Warfarin is a vitamin K antagonist; dabigatran is a thrombin inhibitor; and apixaban, rivaroxaban and edoxaban are direct inhibitors of blood coagulation factor Xa (Graff & Harder, 2013). The traditional drug warfarin targets the vitamin K epoxide reductase complex subunit 1. Warfarin doses are set individually by monitoring the prothrombin time/international normalized ratios or by genotyping drug metabolizing enzymes (Miyagata et al., 2011).
Patient adherence and health management issues: A case study on the effect of medication reminder box
Published in International Journal of Healthcare Management, 2020
Hadi Jafarimanesh, Pegah Matourypour, Saeed Sadrnia, Mehdi Ranjbaran
Anticoagulant treatments are increasingly used to prevent and treat various thrombolytic complications. The goal of the medication is to maintain the level of the medication to prevent the occurrence of thrombolytic events without the occurrence of bleeding complications. The risk of these complications depends largely on follow-up treatment outside of the hospital. In these patients, the duration of the patient’s examination of the PT level outside the hospital should be considered. As a standard, anticoagulation treatments should be accompanied by precise laboratory testing and frequent appointments with a physician. Interactions between anticoagulants and other medications, or the effect of diet on these medications can interfere with the incidence of complications. Therefore, poor adherence to recommended therapies and incomplete medical counselling are known as important factors in the unstable control of anticoagulant treatments [40,41]. According to the researchers of the present study, in Iran, patients are currently receiving individual training by a nurse at the time of being discharged from the hospital. Certainly, choosing the appropriate training method in learning and the patients’ willingness to change their health behaviours are important. Before deciding what method to use, the training goal and financial and human resources of the system should be considered. The use of a medication reminder box is easy and inexpensive in comparison to other available methods, and can cover many patients in different geographical areas.
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