Author Question: You are assigned to care for L.J., a 70-year-old retired bus driver who has just been admitted to ... (Read 73 times)

wrbasek0 · **on:** Jun 25, 2018

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 right leg deep vein thrombosis (DVT). L.J. has a 48pack-year smoking history, although he states he quit 2 years ago.

He has had pneumonia several times and frequent episodes of atrial flutter or fibrillation. He has had two previous episodes of DVT and was diagnosed with rheumatoid arthritis 3 years
ago. Two months ago he began experiencing shortness of breath on exertion and noticed swelling of his
right lower leg that became progressively worse until it extended up to his groin. His wife brought him to
the hospital when he complained of increasingly severe pain in his leg. When a Doppler study indicated a
probable thrombus of the external iliac vein extending distally to the lower leg, he was admitted for bed
rest and to initiate heparin therapy. His basic metabolic panel was normal; other laboratory results were
as follows.

Laboratory Testing
PT 12.4 sec
INR 1.11
aPTT 25 sec
Hgb 13.3 g/dL
Hct 38.9
Cholesterol 206 mg/dL

List six risk factors for DVT.

Question 2

K.N. undergoes knee surgery without complications. Just before his discharge, his physician reviews the instructions and gives him a new prescription for warfarin (Coumadin).

K.N. tells his doctor, I saw this commercial for a new blood thinner called Xarelto. I'd like to take that instead because I wouldn't need to have all this blood work done.

How do you expect the physician to respond?

vkodali · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Most risk factors fall within the three categories of Virchow triad:
Venous stasis: lengthy surgery, immobility, older than age 40, pregnancy, atrial fibrillation, heart
failure, obesity, stroke, denervated limb, hip or knee replacement
Venous endothelial injury: previous DVT, IV catheter, fractures, chemical injury (e.g., cigarette or
tobacco products, elevated glucose), trauma, varicose veins, hypertension
Hypercoagulability: malignant neoplasms, dehydration, oral contraceptives, estrogen therapy,
sepsis, blood dyscrasias, burns, genetic predisposition (i.e., antiphospholipid syndrome, activated
protein C resistance, protein C deficiency, protein S deficiency, antithrombin III deficiency, and
factor V Leiden)

Answer to Question 2

Xarelto (generic name rivaroxaban) is a factor Xa inhibitor that may be used for anticoagulation in
patients with atrial fibrillation. However, K.N. has an artificial heart valve, and rivaroxaban is not
indicated in patients with atrial fibrillation in the presence of heart valve problems.