The Use Of Anticoagulant Therapy And Its Effects On The Treatment

-Blood vessels , Platelets and Coagulation factor : the function of this three components is make thrombus formation.

Warfarin is used most often for long-term prophylaxis of thrombosis. “Specific indications are (1) prevention of venous thrombosis and associated pulmonary embolism, (2) prevention of thromboembolism in patients with prosthetic heart valves, and (3) prevention of thrombosis during atrial fibrillation.”(Lehne, 2010, p. 605). Warfarin is the oral anticoagulant of choice for these indications. The drug has also been used to reduce the risk of recurrent transient ischemic attacks (TIA) and recurrent myocardial infarction (MI).(Lehne, 2010).

Warfarin can lead to severe bleeding risks which may lead to fatality. Those who are over the age of 65 may be more sensitive to warfarin. ( cite)

3. Would it be appropriate to consider treating this patient with tissue plasminogen activator (tPA, alteplase)? How does this drug work?

Lab values during DIC are also of great importance. There is no specific test for DIC but a combination of PT (prothrombin time), aPTT (activated partial thromboplastin time), fibrinogen, platelet count and d-dimmer are used to assist in the diagnosis of DIC (Cunningham, 1999). Since many disorders can cause an increase of each of these lab values, it is important to use the whole picture to make the diagnosis.

During this step, the body has one primary goal; Stop the bleeding (coagulate the blood). In order to reach this goal, as series of clotting factor proteins have

Mr. C.J. is a married 68-year-old African American man who presents to the emergency department with a chief complaint (CC) of emesis of bright red blood. The patient reported that he was shopping when he began throwing up blood at the store. He denied any associated shortness of breath, melena, hematochezia, liver disease, or prior episodes. The patient appears pale, diaphoretic, and he reported some lightheadedness with standing and epigastric pain. On further questioning, he stated that he was admitted in the hospital approximately one month ago with heart palpitation and dizziness and was diagnosed with Atrial fibrillation. Subsequently, he was discharged home with a prescription of 5 mg of Coumadin daily and Tikosyn following a successful cardioversion. Mr. C.J. was also advised to monitor his INR

The bleeding occurs following trauma to the tissue this could be an overload of a tissue or even external force. One of the bodies first initial haemodynamic responses to bleeding is vasoconstriction which narrows the blood vessels causing decreased blood velocity, in 2008 (Watson) states that this is due to the release of noradrenaline(norepinephrine); the reaction last lasts only a few seconds to a minute. It is also explained by (Terkeltaub & Ginsberg, 1988) that both lymphatic and blood vessels are plugged to limit any fluid loss and platelet, aggregation is stimulated by the presence of thrombin. Vasoconstriction responds primarily to haemostasis which is a response to prevent blood loss and a platelet plug is formed to support the prevention of excessive

After injury Platelets adhere to the site of injury, then platelet gets activated and aggregated followed by activation of coagulation cascade and formation of clot.28,29

The blood clotting process known as the coagulation cascade is complex and sophisticated which involves a multi-step. The coagulation process does more durable repairs of the vessel and very essential for closing up larger wounds and maintaining the platelet plug which allows for the formation of thrombus, or clot to form. The cascade process of coagulation is chain reaction because one step leads to next events. In each step of cascade produces a new protein of enzymes or catalysts. The Coagulation cascade leads to three different pathway an intrinsic pathway or an extrinsic pathway and at the end both of which lead to a common pathway. There are 12 known clotting factors involved in three different pathway of coagulation cascade including

begins with damage of capillaries, triggering the formation of a blood clot consisting of fibrin and fibronectin. This provisional matrix fills in the lesion and allows a variety of recruited cells to migrate into the lesion. Platelets present in the blood clot release multiple chemokines, which partici- pate in the recruitment of inflammatory cells, neutrophils, and macrophages, but also in chemotaxis and recruitment of fibroblasts and endothelial cells.

Generally, in a condition where there is an injury with a lesion or cut with bleeding, the blood normally clots in a few seconds. This process where the flow of the blood is blocked by clots by forming a plugs at the sight of any cut or lesion is known as Coagulation.It a very important part of Hemostasis-that is stopping the loss of blood from the blood vessels that are damaged.

Thrombolysis is often used as an emergency treatment to dissolve blood clots that form in arteries feeding the heart and brain -- the main cause of heart attacks and ischemic strokes

A 12 year old boy and his parents enter the emergency room after being involved in a hit and run. The young boy presents with an excessive nose bleed that was reported to have lasted for more than a few hours. Upon first glance, the child has noticeable deep tissue bruising on his arms and legs. The patient’s parents inform the nurse that nose bleeds are very common in their family, ranging anywhere from one to two times a day. However, never has one lasted this long before. Upon further examination, it is noted by a nurse that the child has some elbow and knee joint deformities. Laboratory results show a normal PT/INR, a prolonged aPTT, and a low CBC count. The chest X-Ray and CT scans come back normal for no broken bones or abnormalities. The patient is tested for specific levels of clotting factors in the blood, results came back at 3% present.

It was hypothesised by Rudolph Virchow that irregularities in three parts (Virchow’s triad) lead to the formation and spreading of thrombus. Nowadays it is achievable to measure some of the influences that increase the development of venous thromboembolism (VTE) and other cardiovascular syndromes. The Virchow’ triad suggested that the formation and proliferation of thrombus was caused by (i) blood flow, (ii) vessel wall and (iii) blood components. Irregularities in any of these three areas can lead to formation of thrombus.