Low-molecular-weight heparin has a reliable dose response and can be administered subcutaneously. Warfarin is teratogenic and is contraindicated in pregnant patients. Protamine was administered intravenously, and the bleeding resolved.
Low-molecular-weight heparin has a reliable dose response and can be administered subcutaneously. Warfarin is teratogenic and is contraindicated in pregnant patients. Protamine was administered intravenously, and the bleeding resolved.
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Low-molecular-weight heparin has a reliable dose response and can be administered subcutaneously. Warfarin is teratogenic and is contraindicated in pregnant patients. Protamine was administered intravenously, and the bleeding resolved.
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and swelling in her right leg presented at the emergency room. An ultrasound study showed thrombosis in the popliteal vein. The patient, who was in her second trimester of pregnancy, was treated for 7 days with intravenous unfractionated heparin. The pain resolved during the course of therapy, and the patient was discharged on Day 8. Which one of the following drugs would be most appropriate out-patient follow-up therapy for this patient, who lives 100 miles from the nearest hospital? A. Warfarin. B. Aspirin. C. Alteplase. D. Unfractionated heparin. E. Low-molecular-weight heparin (LMWH).
Correct answer = E. LMWH has a reliable dose
response and can be administered subcutaneously by selected patients who have been taught home injection technique. LMWH does not cross the placenta and shows no teratogenic effects. By contrast, warfarin is teratogenic and is contraindicated in pregnant patients. Aspirin, which inhibits platelet aggregation, has little effect on venous thrombosis, which is composed of fibrin with only a few platelets. Alteplase is not indicated for deep-vein thrombosis. Edited by Foxit Reader Copyright(C) by Foxit Software Company,2005-2008 For Evaluation Only.
20.2 A 60-year-old man is diagnosed with deep-
vein thrombosis. The patient was treated with a bolus of heparin, and a heparin drip was started. One hour later, he was bleeding profusely from the intravenous site. The heparin therapy was suspended, but the bleeding continued. Protamine was administered intravenously, and the bleeding resolved. The protamine: A. Degraded the heparin. B. Inactivates antithrombin. C. Activates the coagulation cascade. D. Activates tissue-plasminogen activator. E. Ionically combines with heparin.
Correct answer = E. Excessive bleeding may be
managed by ceasing administration of the drug or by treating with protamine sulfate. Infused slowly, protamine combines ionically with heparin to form a stable, inactive complex. 20.3 A 54-year-old male with a prosthetic aortic valve replacement complained to his family physician of black and tarry stools. Physical examination and vital signs were unremarkable except for subconjunctival hemorrhages and bleeding gums. Stools tested positive for heme, and hematuria was observed. The patient has been receiving oral warfarin since his valve replacement 1 year earlier. Prothrombin time was found to be significantly elevated. Which one of the following therapies would provide the most rapid recovery from the observed bleeding secondary to warfarin treatment? A. Intravenous vitamin K. B. Transfusion of fresh-frozen plasma. C. Intravenous protamine. D. Immediate withdrawal of warfarin treatment. E. Intravenous administration of anti-warfarin antibodies.
Correct answer = B. Whole blood, frozen plasma, or
plasma concentrates of the blood factors may be employed to rapidly arrest hemorrhaging. Minor bleeding may be treated by withdrawal of the drug and administration of oral vitamin K1; severe bleeding requires greater doses of the vitamin given intravenously. However, reversal following administration of vitamin K takes approximately 24 hours. Protamine is used to neutralize an overdose of heparin, not an overdose of warfarin. Immediate withdrawal of warfarin treatment will not have an immediate effect, because the anticoagulant effects of warfarin last between 5 and 7 days.