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  #1  
Old 02-13-2013
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Drug Bleeding after anticoagulation

52 year old man with history of deep vein thrombosis is in the hospital, preparing for a routine surgical procedure next day. He has been taking an oral anticoagulant for the past 5 years. On arrival at the hospital, he is switched to an intravenously administered drug for the duration of his stay. In the morning of his surgery, he awakens to find large bruises covering his arms and legs and blood oozing from his gums. A full blood panel reveals bleeding time of 5 minutes, PTT of 150 seconds, and PT of 12 seconds. If this patient had had this presentation 5 – 7 days after the onset of his intravenous drug therapy, what medication could be given to help treat his condition?

A. Fresh frozen plasma
B. Vitamin K
C. Heparin
D. Protamine Sulfate
E. Lepirudin
F. tPA
G. Warfarin
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A. Fresh frozen plasma
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LOST.

D. maybe, possibly?
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Default E

D , likely.

Last edited by fasha; 02-13-2013 at 10:12 PM. Reason: a mistake
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Old 02-14-2013
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a...ffp


??????
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A- fresh frozen plasma
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I think the ans is A. Fresh frozen plasma, because it dates less than 24 hours, still contains all clothing factors as well as platelets, and could thus solve the coagulation defect
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Quote:
Originally Posted by dydy7 View Post
I think the ans is A. Fresh frozen plasma, because it dates less than 24 hours, still contains all clothing factors as well as platelets, and could thus solve the coagulation defect
Isn't fresh prozen plasma used for the fast reversal of Heparin overdose and Warfarin is not given IV, but Orally.

I think the question is asking about the drug which would be given IV,and heparin is the one which is injected IV.So to reverse the toxicity of Heparin , we would give Protamine to the patient.

I would go with D. Protamine Sulfate.
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so whats the correct answer?

someone explain why his PTT is off the roof?
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Quote:
Originally Posted by mdsoon View Post
so whats the correct answer?

someone explain why his PTT is off the roof?
Heparin is intrinsic and will increase PTT.
WARfarin is Extrinsic and will increase PT. (Mnemonic from FA: The EX PresidenT went to WAR).

So its if you give heparin IV for 7 days, the pt can probably get toxicity and then to reverse that, Protamine is given.
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that was actually my train of thought and i guessed D.


Thanks.
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Should I post the answer now or should I wait another eight hours? So far, wrong answers are posted.
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Quote:
Originally Posted by Doctor Ali View Post
Should I post the answer now or should I wait another eight hours? So far, wrong answers are posted.
Post the answer.Kill this curiosity.
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NOOOWWWWW
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Quote:
Originally Posted by Doctor Ali View Post
Should I post the answer now or should I wait another eight hours? So far, wrong answers are posted.
By the way before you post the right answer...If the time is an issue and the above answers are wrong then we are left with Vitamin K.lolz
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52 year old man with history of deep vein thrombosis is in the hospital, preparing for a routine surgical procedure next day. He has been taking an oral anticoagulant for the past 5 years. On arrival at the hospital, he is switched to an intravenously administered drug for the duration of his stay. In the morning of his surgery, he awakens to find large bruises covering his arms and legs and blood oozing from his gums. A full blood panel reveals bleeding time of 5 minutes, PTT of 150 seconds, and PT of 12 seconds. If this patient had had this presentation 5 7 days after the onset of his intravenous drug therapy, what medication could be given to help treat his condition?[/FONT][/SIZE]



E. Lepirudin

It is not inhibited by PF4 therefore successful in treatment of HIT.
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Last edited by neha_subh; 02-14-2013 at 08:25 AM.
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Correct Answer Correct answer is Lepirudin

Lets break this up.

1. This man has DVT and has taken oral anticoagulants for past 5 years. Most likely Warfarin in this case.

2. Upon hospital, he is SWITCHED to IV. This has to be Heparin because again he has history of DVT.

3. In the morning, there were bruises all over. Then the staff members did the blood test for this guy and saw what happen/why he was in bruises.

4. Lab values: bleeding time normal, PT normal, PTT increased.
Here, we can get rid of Fresh frozen plasma, and Vitamin K. Why? Because his PT is normal and hes not on Warfarin either because he was SWITCHED from Warfarin to Heparin.

5. His PTT is increased, indicating that hes on Heparin. Now you wont want to give Heparin to Heparin overdose, right? So we can get rid of heparin. tPA itself has no business here so we can get rid of that as well.

6. Now we are left with Protamine Sulfate and Lepirudin.

We see that this patient has increased PTT which is caused by Heparin overdose. Therefore, you would give Protamine Sulfate. But this is not the entire case. The question itself is asking:
If this patient had had this presentation 5 7 days AFTER THE ONSET of his intravenous drug therapy, what medication could be given to help treat his condition?

In other words, this patient has Heparin overdose + something else as of right now; what he will present in 5 7 days later?

Ladies and gentlemen, this patient has Heparin overdose due increased PTT and he finds large bruises covering his arms and legs and blood oozing from his gum. Put them together and these are symptoms of thrombocytopenia. As the time goes by, he will eventually develop Heparin Induced Thrombocytopenia. Had this patient presented with symptoms of Thrombocytopenia 5 7 days after the initial IV Heparin treatment, he would be suffering from development of Heparin Induced Thrombocytopenia. Heparin Induced Thrombocytopenia predisposes to thrombosis and exacerbate previously diagnosed blood clot. But still why Heparin Induced Thrombocytopenia? Recall that when he woke up he finds large bruises covering his arms and legs and blood oozing from his gum.

The treatment here therefore, would be Lepirudin.
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  #18  
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I hope that I made it clear, because I was confuse after reviewing what I was trying to explain.
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We where treating for excessive anticoagulation and answer appears to be more anticoagulation
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Quote:
Originally Posted by Doctor Ali View Post
I hope that I made it clear, because I was confuse after reviewing what I was trying to explain.
how will u explain normal bleeding time with thrombocytopenia
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Quote:
Originally Posted by crusader View Post
how will u explain normal bleeding time with thrombocytopenia

Heparin Induced Thrombocytopenia - what is this? Heparin Induced Thrombocytopenia is Heparin binds to platelet factor IV, causing antibody production that binds to and activates platelets leading to their CLEARANCE and resulting in thrombocytopenic, hypercoagulable state.
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