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To Clot Or Not To Clot…
Emergency Care for Coagulation Disorders/Conditions
Rebecca Goldsmith Pediatric Thrombosis/Hemophilia Nurse
McMaster Children’s HospitalCurrent Concept in Pediatrics
October 16th, 2009
Objectives
Virchow’s TriadReasons for referrals Line related DVTsAnticoagulation of DVTsCase study – keypad questionClinic informationQuestions
Reasons for Referrals
Prothrombotic workupDeep Vein Thrombosis (DVT)Pulmonary Embolism (PE)StrokeFracture prophylaxisArterial thrombosis
Reasons for Anticoagulation
DVT Cardiac prophylaxis(BT shunt, Fontan
procedure, Norwood procedure) Fracture prophylaxis Arterial clot Hereditary prothrombotic states Stroke (pediatric pts. cerebral sinovenous
thrombosis, CSVT) however, there is not a lot of evidence to support this
Line related DVTs
Clinical observation• CVL dysfunction• Limb or facial swelling distal to a CVL
insertion site• Superficial new collateral vein
development• Pain, swelling, or redness in limb• Abdominal pain +/- fever without other
explanation
LMWH
Advantages Disadvantage
* Subcutaneous injections daily or twice daily
minimal monitoring required
reduced risk of interaction with other medication or diet
reduced risk of heparin induced thrombocytopenia (HIT)
probable reduced risk of osteoporosis in long-term
Warfarin Therapy
Advantages
Taken per os no injections
Disadvantages *Therapeutic range of INR must be in place at least two consecutive days prior to removing LMWH
* many drug interactions (ex. Antibiotics)
* interacts with diet high in Vitamin K enriched foods
*reduced bone density in pts taking warfarin for more than one year
Case Study Question-
A 17 yr old female presents in ER. She appears anxious, sweating. She has a rapid HR and low BP. c/o sharp chest pain and shortness of
breath. She admits to taking oral contraceptive pills for three months.
You suspect which of the following?
1. Myocardial infarct 2. Pulmonary embolism3. Pregnancy4. Panic Attack
Clinic Information
Pediatric Thrombosis ClinicHamilton Health Sciences1200 Main St WestHamilton905-521-2100 ex 75970
References
Monagle, P., Chan, A.K.C., deVeber, G, Massicotte, M.P. (2006).Pediatric Thromboemolism and Stroke (3rd ed.). Hamilton, ON: B.C. Decker Inc.
Resources:Machealth.caThrombosis Interest Group of Canada
http://www.tigc.org/