Episodic Care: DVT Notes (pp.

975-982) Venous thrombosis is the most common disorder of veins o Formation of a clot (thrombus) that is associated with an inflammation of the vein o Classified as superficial thrombophlebitis or deep venous thrombosis (DVT) Superficial thrombophlebitis is the inflammation of a vein occurs in 65% of clients receiving IV therapy (minor significance) DVT occurs when a thrombus is a deep vein, commonly in iliac or femoral o Can be life threatening b/c it can lead to pulmonary embolism Three important factors: venous stasis, damage to the endothelium and hypercoagulability o Venous stasis valves are dysfunctional or muscles in extremities are inactive; occurs commonly in obesity, CHF or on long trips w/out exercise, or are immobile for long periods of time o Endothelial damage caused by trauma or external pressure In superficial thrombophlebitis, clients have a palpable, firm, SQ cordline vein. Area around it is red and warm, mild systemic temperature may be present. Common cause in the upper extremeties is trauma from IV therapy and lower extremeities is due to varicose veins. In DVT, there are no real symptoms, unless the super vena cava is involved. Then you would notice symptoms in the upper extremities, face, neck and back. Anticoagulants are used for DVT so it prevents propagation of a clot, development of new clots and embolization. Does not dissolve the clot. Commonly used anticoagulants is unfractionated heparin (UH), low molecular weight heparin (LMWH), hirudin derivatives and coumarin comounds o UH act on intrinsic and common pathways of blood coagulation Heparin inhibits thombin-mediated conversion of fibrinogen to fibrin Potentiates action of antithrombin III and inhibits activation of factor X o LMWH prevents and treats DVT; derived from heparin but the moleculr size is 1/3 of heparin Greater bioavailability more predictable dose response and longer half life and less risk of bleed complications Does not require monitoring and dose adjustgement Administer SQ in fixed doses or q1d or q2d o Hirudin manufactured from recombinant technology; binsd with thrombin nearby and inhibits its function without causing platelet reduction; not reversible and no antidote if bleed occurs Iv infusion

o Coumarin compound of warfarin (Coumadin) most commonly used. Indirectly acts on coagulation pathway, inhibits hepatic syntehsisof the vitamin K dependent coagatoin factors: II, VII, IX and X