• First order of business is to treat her DVT.
• Prevent a pulmonary embolus.
• Low molecular weight heparin.
• In time, shift her over to Coumadin.
• If she's on birth control pills, they need to go.
• Estrogens increase clotting potential.

• Estrogens displace Coumadin from binding proteins
• Means more Coumadin available to inhibit clotting protein synthesis.
• When it comes time to shift her to Coumadin, the INR should be a little longer.
• With a typical DVT, we'd be shooting for an INR between 2 and 2.5.
• But in the case of APS it's recommended to go to at least 3 and
• Some doctors even add a daily baby aspirin.
• Avoid the post phlebitic syndrome,
• Use compression stockings
• We don't want to forget about her arthritis and she seems to be mildly anemic.
• But these are problems for another case study.

The numbers make you think APS is a bleeding problem, but it's really a clotting disorder.

Fascinating. I'm up for it now. What's next?                                                       Back