Background
Prosthetic heart valve replacement is performed in several hundred thousand patients per year worldwide and is recommended for many patients with severe valvular heart disease. Bioprosthetic heart valves and mechanical heart valves are the two major valve types. Mechanical valves are more durable than bioprosthetic valves but require lifelong anticoagulant therapy with vitamin K antagonists (warfarin) due to persistent risk of thrombosis and stroke. Warfarin has a narrow therapeutic window and requires frequent monitoring such as international normalized ratio (INR) and restrictions on food, drugs and alcohol. Due to limitations of warfarin many patients prefer bioprosthetic valve replacement rather than a mechanical valve, despite the risk of premature valve failure and repeated valve replacement surgery with bioprosthesis.1 Warfarin works by inhibiting coagulation factors II, VII, IX and X, as well as proteins C and S and hence reduces synthesis of active clotting factors.4
Dabigatran is a direct reversible thrombin inhibitor that has been approved for treatment of nonvalvular atrial fibrillation (AF) based on results of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study, but its use for other indications remains untested. It works by inhibiting both free and clot-bound thrombin, which enables the conversion of fibrinogen into fibrin. Dabigatran is eliminated primarily by the kidneys and it’s dosed orally.5
Literature search
A literature search was conducted using EMBASE database (1980 to 2014 Week 06) and MEDLINE database (1946 to February Week 2 2014) accessed through Ovid. The databases were accessed on February 8, 2014. Keywords included dabigatran etexilate, warfarin, thrombosis, and...
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...e of warfarin over dabigatran as the preferred anticoagulant for the prevention of thromboembolic and bleeding complications in patients with mechanical heart valves. o Warfarin starting dose 2 to 5 mg orally/IV once a day.3,4 o Dose adjustment should be based on the results of INR.3,4 o Usual maintenance dose 2 to 10 mg orally/IV once a day.3,4
• Monitoring parameters o Daily monitoring for INR following initial dose until INR stabilized to the therapeutic range, then every 4 weeks based on clinical need.3,4 o Target INR of 2.5 (range 2 to 3 for aortic mechanical valve).3,4 o Target INR of 3 (range 2.5 to 3.5 for mitral mechanical valve)3,4
Thank you for this consult. I will continue to follow up with you on this patient. If you have any questions, please do not hesitate to contact me via email.
Augustine Owusu PharmD candidate
Email: Augustine.owusu@my.mcphs.edu
Nishimura, R. A., & McGoon, M. D. (1999). Editorial: Perspectives on mitral-valve prolapse. The New England Journal of Medicine, 341(1), 48-50. Retrieved from http://search.proquest.com/docview/223939414?accountid=158514
Many factors can increase the risk of these clots, including prolonged bed rest (such as after surgery), sitting for long periods (such as on a plane), use of birth control pills or hormone replacement therapy, pregnancy, family history of DVT, inflammatory bowel disease, and certain genetic clotting disorders. Compression stockings are also sometimes used in people who have an acute DVT, to prevent a group of symptoms known as post-thrombotic syndrome that includes leg pain and
“Chronic diseases and illnesses are the leading causes of death and disability in the United States” (CDC.gov, 2014). These types of illnesses are the most common health problems that people in this country face today and they are also the most preventable (CDC.gov, 2014). Every year the cost to help care for and manage people with these types of illnesses increases and there is less being done about educating people about prevention. Venous Thromboembolism is one such chronic disease that is very deadly but also very preventable if the right precautions are taken. This paper will aim to educate about the disease, courses and costs of treatment, clinical microsystems that are involved and what barriers if any exist to achieving generative relationships among the various clinical microsystems involved.
Ofri, D (2000). Diagnosis and Treatment of Deep-Vein Thrombosis. Western Journal of Medicine; 173: 194-197.
...6 and Sitagliptin at week 52 (p <0.001). Canagliflozin 100 mg and 300 mg reduced body weight vs placebo (week 26: –3.7%, –4.2%, –1.2%, respectively; p <0.001) and sitagliptin (week 52: –3.8%, –4.2%, –1.3%, respectively; p <0.001). Both canagliflozin doses reduced FPG and systolic BP vs placebo (week 26) and sitagliptin (week 52) (p <0.001).5
The next stage in myocardial infarction is the formation of thrombus. Exposure of the subendothelial matrix of the plaque to blood due to superficial abrasion generates platelet activation and aggregation. Clotting factors on the platelet membrane carry out reaction which release prothrombin activator, this activator then converts prothrombin to enzyme thrombin. The transformation of fibrinogen to fibrin is then catalysed by thrombin. During proteolysis (the breaks down of protein), fibrinogen is converted to fibrin strands which stabilize the final blood clot. Complete occlusion of coronary artery by thrombus disrupts blood flow and causes ischemia due to atherosclerotic coronary artery steno...
Nelson BSN, RN, Roxanne. "Controversay Surrounds Gardasil." AJN, American Journal of Nursing 108.7 (2008): 17. Print.
This patient is very friendly and sociable. He was able to answer my questions without hesitation. He comes for weekly treatment of IVIG. He stated that he accepted his disease/illness and will do his best to live normal like everybody else. He stated his family especially his mother has always been there for him and see his mom sometimes tired. I was able to perform my head to toe assessment without any
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
Further, after the assessment has been completed a diagnosis is determined by using the DMS IV. Patients must show signs of at least 3 of the following for 12 months: Tolerance which the drug has little to no effect, psychical or psychological signs of withdrawa...
... Medicine. 3rd ed. Vol.3. Detroit: Gale, 2006.2139-2141. Gale Virtual Reference Library. Web. 3 Apr. 2014.
JAMA: Journal of the American Medical Association. 14 Nov. 2001: 2322. Academic Search Complete. Web.
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
... you should take baby aspirin (81 mg). The earlier a patient takes preventative measures the less a patient has to worry about taking other medication such Warfarin which have many adverse side effects such as excessive bleeding. Patients need to continuously check legs for any signs and symptoms of DVT.
The purpose of this paper is to analyze, diagnose, and to determine a proper treatment plan to work toward the beneficial prognosis for the individual indicated within the case study.