What is the line of treatment for DVT.young guy 23 yr suffering from DVT.
go step wise . start inj lmwh 1.5mg/kg/day along with tablet warfarin 5mg OD at 7p.m. daily with inr monitoring ( inr to be kept between 2-3 ) titrate warfarin dose accordingly to inr . **Note : as per the new recommendations warfarin and heparin are to be started on same day and once inr is between 2-3 then heparin can be stopped . If patient is affording for lmwh injections for entire duration of therapy then patient does not require warfarin neither inr monitoring. dere is no need for ct pulmonary angiogram as already thrombosis is proven as dvt cz management for pulmonary embolism remains the same . total duration of therapy is for 3-6 months depending upon clinical response . simultaneously assessment for requirement of thrombolysis is required . am writing guidelines in brief but go through dem itself for better understanding . 1.hemodynamic status of patient wether in shock or not 2. PESI score if positive or not 3. get 2d echo done to look for signs of RA/RV dysfunction and pulmonary hyprtnsn 4. trop t and cpk mb : for cardiac markers of injury if patient in shock directly send for thrombolysis . for others depends upon clinical condition . apart from this ambulation for patient is to be decided depending upon site of dvt . if above knee dvt then ambulation to be restricted for some time to prevent dislodgement of thrombus . If below knee then ambulation to be encouraged . give compression stockings . and my advice would be to refer to a specialist as these ases worsen anytime . As u r not an expert in such tricky situations refer to a higher centre
look for clinical symptoms... if dyspnea , get HRCT to r/o pulmonary thromboembolism.....according to clinical presentation of case treatment ranges from.....thrombolysis....LMWH...warfarin
IV heparin long acting infusion.Or Short acting daily inj.Overlap with oral warfarin for atleast 36 hours Titrate the dose of oral warfarin by measuring PT or INR.PT one and half times normal.Or INR value around 3.Continue the treatment for 6 months.PT and INR to be measured and maintained.
young pt with DVT uni/bilateral cause? treatment with leg elevated LMWH with BT/ct/pt monitoring. glycerine magsulf dressing with stockinette keep warm on chances of pulmonary embolism follow up with venous Doppler study
Get the opinion of cardiovascular surgeon.
ofcourse not to forget....keep close watch on bleeding tedency with BT CT PT INR....
admit the pt...start conventional heparin ..infusion...monitor aptt ...an titrate...acordingly...for atleast 5 to 7days....replace (overlap)it with anticoagulant...on 5 thday...stop heparin on 7 th day...an continue anticoagulant for at least three months...!!!an monitor PT first after one week an then every 21 days...titrate the dose accordingly...!!!
detailed history...including number of episode in past,family history...,long immobilization..reccurent dyspnoea....or diet history orany other relevant history u cn ask....!!!to find out the cause....!!!an to treat the pt..an deciding the duration of treatment..!!
start with lmwh like daltaparin 60 iu sc bd. get PT INR done third day start with warfarrin till INR is achieved to 2 and then stop lmwh
the best Medicineless treatment is ... do static dry Needling at gastrocnemius ..both head ,soleus and tendoachillis ...to induce reflex relaxation. and to release tension in these muscle fibers and decrease compartmental pressure ..which leads to normalise blood circulation ... and this is 100% going to effect. ..
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