Very Sociable Guy

Chest Pain

Girl with a Rash  

England 1944

Trouble Healing

Morning Stiffness

Bruises Easily

Shortness of Breath

Drug Interactions

Review

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• If there is a DVT with pulmonary embolus, we're treating the life threatening aspect as well as the clotting system.
• Oxygen and supportive cardiac/pulmonary management.
• Unfarctionated heparin to get the aPTT out 2 to 2.5 times the reference.
• Interestingly, low molecular weight heparin does not affect the aPTT, so it is dosed based on the weight of the patient.
• Also, protamine does not totally reverse the effects of low molecular weight heparin.
• If it's an uncomplicated DVT, we go with heparin with prolongation of aPTT as above.
• Patients are gradually weaned from heparin while they are being placed on Coumadin.
• By convention, we use
• aPTT to monitor heparin and
• PT to monitor Coumadin therapy.
• Both tests are prolonged with either heparin or Coumadin, but since factor VII levels are quick to rebound, we use the PT to follow patients on Coumadin.
• Coumadin is taken orally, it's cheap and we have considerable experience with it.
• For most purposes, we're shooting for an INR between 2 and 3.
• Rarely do we treat someone to a value of over 3, APS being the one exception.
• One advantage of heparin is that its effect can be quickly reversed with protamine.
• Coumadin is not without its problems.
• It takes time to reverse with vitamin K. Up to 6-8 hours.
• Protein C and S are also vitamin K dependent proteins. They drop too.
• You can clot while on Coumadin.

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