Management

If the patient is not auto-anticoagulated, prophylactic low molecular weight heparin (5000 IU od SC) should be given for long term immobility/paralysis and to high risk patients (e.g. previous DVT, femoral fractures).

For pulmonary embolism or deep vein thrombosis give 200 IU/kg SC daily (or 100 IU/kg bd if at risk of bleeding).

Partial thromboplastin times (PTT) should be checked regularly if giving unfractionated heparin and maintained at approximately 2-3 x normal. Monitoring is not necessary for LMW heparin though anti-Factor Xa levels can be used.

Intra-arterial clot can be treated with local infusion of thrombolytics, usually followed by heparinisation. Seek vascular surgical advice.

Axillary vein or subclavian vein thrombosis should be managed by elevation of the affected arm, e.g. in a Bradford sling, and heparinisation.

Specific conditions may require specific therapies, e.g. plasma exchange for SLE and TTP, whole blood exchange for sickle cell crisis.

Warfarinisation should generally be avoided until shortly before ICU discharge because of the risk of continued bleeding following routine invasive procedures such as central venous catheterisation.

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