Development of a venous thromboembolism
Thromboembolism (VTE) You are assigned to care for L.J., a 70-year-old retired bus driver who has just been admitted to your medical floor with a right leg venous thromboembolism (VTE). L. J. has a 48 year smoking history, although he quit 2 years ago. He has had 2 previous episodes of VTE in his right leg and was diagnosed with osteoarthritis 3 years ago. Two days ago he began noticing swelling of his right calf with redness and pain. His wife brought him to the hospital when he c/o increasingly severe pain in his leg. When a Doppler study indicated a probable thrombus of the great saphenous vein distally in the lower leg, he was admitted and started on a continuous intravenous unfractionated heparin protocol. Admission lab values are PT 12.4 sec., INR 1.11, PTT 25 sec., Hgb 13.3 g/dL, Hct 38.9%, cholesterol 206 mg/dL. Basic metabolic panel is normal.
1. Identify L.J.’s risk factors for the development of a venous thromboembolism (VTE). Explain how they pertain to the principles of Virchow’s Triad in your discussion.
2. Discuss the assessment findings/clinical manifestations L.J. is exhibiting indicative of VTE. How do these manifestations differ from lower extremity arterial disease?
3. Give examples of unfractionated and low-molecular weight heparin therapy. Explain how they are administered. What lab diagnostics must you monitor with heparin therapy? What is heparin’s antidote?
