You have prescribed warfarin to mother of one of your medical students named AvatarHappy-2. Three days later they return back & complain of dark 3x4 cm necrotic area on his neck. You have to explain to your student this is some thing related to clotting factors. On which concept you will base your conversation on?
A: Onset of action
B: Half life of action
C: Clotting facter deficiency
D: Clotting factors mutation
E: Underlying malignancy
It could be B or C ? But the best answer in my opinion would be C) Clotting factor (specifically Protein C) deficiency.
We have to talk about both Half Lives and Protein C deficiency.
The patient is having the adverse effect of skin necrosis. When a patient is started on warfarin therapy, there can be a transient protein c deficiency leading to Hypercoagulability because factors VII & Protein C have the shortest half-lives of all the coagulation factors. Therefore, if you have decreased Protein C (transient increase in coagulation), you will not be able to inactivate factors Va & VIIIa and there for the intrinsic system remains active for a few days.
Ah, ok thanks. So i guess i had the mechanism right but chose the wrong answer Man, these questions can get confusing sometimes!! So the answer is B) Half Life of action?
its clotting factor mutation.
pts wid factor v leiden mutation r prone to skin necrosis after warfarin bcoz of faster inactivation protein c(after factor 7) thn the other factors
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