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Old 06-01-2015
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Default case from goljan audio, help plz

from audio day 3 file 6 last couple of minutes ....
older man with osteoarthritis – prostate was resection and massive bleeds: if have osteoarthritis, you have pain,
and if you have pain, you will be on pain medication, an NSAIDS, and will give test results – PT/PTT/platelet count all normal – bleeding time is longer. Rx – platelet pack transfusion – when you give from a donor, it WILL work (donor’s platelets are normal). So, if your taking NSAIDs, platelets not working and if you have a prob during surgery, give pt
platelets from donor.

1- how nsaids will increase the bleeding time i thought only aspirin can work as antiplatlets
2- is not the most likely cause for this case that because the prostate is one of the tissues rich in tissue plasminogen activator, the patient won't be able to maintain clot due to getting lysis very fast
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Old 06-02-2015
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I think you are right Prostate is like a house stored with Urokinase(like tPA) so the bleed that this patient might be getting is not due to NSAIDs rather than Urokinase from the prostate but then again NSAIDs will result in lowering of TxA2(Thromboxane A2) production and will hamper platelet aggregation!

Now I think what the question focuses on is that the man didnt stop NSAIDs 8-10days before his surgery so all his platelets have screwed up COX-2 so infusing a fresh batch might stop the bleed!

Just a guess although your logic seems more correct
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Old 06-02-2015
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what i really wonder about that considering NSAIDS strong enough to mess up with plateletes aggregation ..i didn't find any book say they can do that and at the same time why they can't do that if they are able to knock off the cox-2 like aspirin do.. we even use them in postoperative pain .are we not afraid if the patient tear his stitches during take nsaids
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