Siti Nurul Afiqah binti Johari (10-6-95)

Clinical picture

Investigationsi. Laboratory: • ABG: might be normal, type 1 RF, severe hypoxemia, mild

hypocapnea• D-dimer

ii. ECG: Sinus tachycardia, Rt BBB, ST-T abnormalities

iii. Radiological:• Chest X-ray• CTPA• V/Q lung scan

What to consider in geriatrics?

• Sensitivity to the anticoagulant effect of a given dose increases with age

• Polypharmacy (include self med) increases risk of drug interactions which alter oral anticoagulant effect or which increase the risk of bleeding

• Increased prevalence of concurrent or intercurrent illness

• Decreased compliance or decreased access to monitoring

Prophylaxis• Patients who undergone

surgery, 4-6 weeks of LMWH or UFH

• Graduated compressive stockings and pneumatic compression devices

Treatment• LMWH prevents clot formation

and extension given SC 1/2x a day

• Long term anticoagulation after discharge is warfarin

• Thrombolytic therapy with massive PE who have significant pulmonary HTN, obstruction of multiple segments of pulmonary circulation, rt ventricular dysfx or systemic hypotension

• IVC filter in special circumstances