1/43. factor v Leiden mutation: a nursing perspective.The factor v Leiden mutation is a recently described autosomal dominant genetic risk factor for venous thromboembolism (VTE). persons who are heterozygous or homozygous for this disorder are at 4 to 7 times and 50 to 100 times increased risk, respectively, for VTE. In particular, women have unique challenges because the presence of the Leiden mutation in combination with pregnancy or use of oral contraceptives results in an even greater increased risk for VTE. This article will review the factor v Leiden mutation, its association with VTE, and the genetic inheritance pattern and ethnic distribution. Oral contraceptive use, pregnancy, and hormone replacement therapy in women with the Leiden mutation will be discussed. Screening issues and management for all patients, and women in particular, will be addressed. nursing implications for care management of this group of patients is complex and requires evaluation of the significance of newly defined genetic disorders such as the factor v Leiden mutation. nurses need to be knowledgeable about genetic screening, risk factors, risk-reduction counseling, and considerations for long-term therapy, which include quality of life issues. Two case studies exemplify many of the issues that will be discussed.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/43. Coexisting dysfibrinogenemia (gammaR275C) and factor v Leiden deficiency associated with thromboembolic disease (fibrinogen Cedar Rapids).fibrinogen Cedar Rapids is a heterozygous dysfibrinogenemia (gammaR275C) that was associated with thromboembolism during and following pregnancy in three second-generation family members who also were heterozygotic for factor v Leiden (V R506Q). Like other dysfibrinogenemias with substitutions at position 275 of the gamma-chain, fibrinogen Cedar Rapids is characterized by defective end-to-end intermolecular fibrinogen and fibrin 'D : D' associations, a fibrin network structure that is composed of thicker and more highly branched fibers, normal fibrin 'D: E' associations, and normal factor xiii-mediated crosslinking of fibrinogen and fibrin. In addition, Cedar Rapids fibrinogen and fibrin displayed delayed plasmin lysis rates. Compared with normal fibrinogen, platelet aggregation or platelet fibrinogen receptor clustering was defective in the presence of fibrinogen Cedar Rapids. Most subjects with gammaR275 mutations do not experience clinical thrombotic disorders, suggesting that the combination of a factor v Leiden defect and a gammaR275C dysfibrinogenemia predisposes to thromboembolic disease.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
3/43. Libman-Sacks endocarditis in a pregnant woman with acute respiratory distress syndrome.BACKGROUND: Sterile fibrinous vegetations on the mitral valve (Libman-Sacks endocarditis) might be found in one-third of patients with antiphospholipid antibodies. Usually of minor hemodynamic significance, these vegetations might complicate acute respiratory distress syndrome in pregnancy. CASE: Despite delivery and aggressive medical therapy, a 17-year-old primigravida with pyelonephritis and acute respiratory distress syndrome suffered rapid decompensation. echocardiography showed mitral valve vegetations with severe regurgitation. Blood cultures were negative, but antinuclear antibody test and lupus anticoagulant were positive. The patient died of massive cerebral infarction and brainstem herniation. autopsy found a patent foramen ovale and Libman-Sacks endocarditis. CONCLUSION: With rapid decompensation of acute respiratory distress syndrome in pregnancy, despite aggressive medical therapy, complicating processes must be considered, especially with antiphospholipid antibodies, which can be associated with sterile heart vegetations and subsequent fatal thromboembolism.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
4/43. Thromboembolic prophylaxis with danaparoid (Orgaran) in a high-thrombosis-risk pregnant woman with a history of heparin-induced thrombocytopenia (HIT) and Widal's disease.There is no consensus concerning thromboembolic prophylaxis in high-risk pregnant women with a previous history of heparin-induced thrombocytopenia. An alternative anticoagulant therapy is danaparoid, whereas unfractioned and low-molecular-weight heparin therapy is contraindicated. We report a case of successful thrombosis prophylaxis using danaparoid in a high-thrombosis-risk pregnant woman with a history of heparin-induced thrombocytopenia during a previous pregnancy and Widal's disease.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
5/43. Vena cava thrombosis associated with nephrotic syndrome in the puerperal gestational cycle.CONTEXT: The puerperal gestational cycle is accompanied by a state of physiological hypercoagulability. Thromboembolic phenomena may occur at this time. OBJECTIVE: To report on a clinic case involving a patient that presented a family history of thromboembolism and developed deep vein thrombosis in a lower limb and vena cava thrombosis during the puerperal gestational cycle, displaying nephrotic syndrome as the main complication. DESIGN: Case report.- - - - - - - - - - ranking = 0.28707709575777keywords = gestation (Clic here for more details about this article) |
6/43. Accumulation of low molecular mass heparin during prophylactic treatment in pregnancy.A history of thromboembolism is associated with an increased risk of new thromboembolic events during pregnancy. Prophylaxis with heparin during pregnancy implicates long-term treatment with daily injections with either unfractionated heparin (UFH) or low molecular mass heparin (LMMH). Prolonged treatment with heparin may result in endothelial absorption and drug accumulation. In order to test this hypothesis, anti-FXa activity during pregnancy was measured in four women allergic to conventional UFH, who were treated with LMMH (dalteparin; Pharmacia). It was found that, at the commencement of treatment, it took more than 8 days to reach a steady maximum peak value, located 3 h after the given dose. One daily dosage of 5,000 IU anti-Xa resulted in a measurable level of FXa for 24 h in pregnancy week 40, compared with 17h at pregnancy week 37. The implications of an elevated anti-FXa activity during pregnancy, especially during the third trimester and at partus, are discussed. We present a reduced dose regime near term and during delivery.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
7/43. Anticoagulation during pregnancy.Anticoagulation of a pregnant woman is a complex issue for both the treating physician and the patient. In patients with mechanical prosthetic valves, long-term anticoagulation is mandatory to prevent thromboembolic complications; and in those with thrombophilic disorders and history of thromboembolism, anticoagulation is strongly indicated. With an increase in the number of patients with prosthetic heart valves, as well as the increase in maternal age, the issue of anticoagulation has become a very important one. Despite the widespread use of warfarin and unfractionated heparin during pregnancy, the optimal use of anticoagulants during pregnancy remains controversial because of a lack of appropriate prospective randomized clinical trials. In fact, even retrospective data on heparin provide miserably inadequate information for those making a decision on the correct dosing regimen. More recently, low molecular weight heparin has been proposed as a safer method of anticoagulation. This review summarizes current data and recommendations on anticoagulation during pregnancy.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
8/43. Thromboprophylaxis with low molecular weight heparin in thrombophilia-complicated pregnancy.We treated three thrombophilia-complicated pregnant women (two antiphospholipid antibody syndrome, one protein c deficiency) with low molecular weight heparin (dalteparin). All three pregnancies including one twin pregnancy ended in live births without a decrease in bone mineral density. This treatment modality was effective and safe preventing thrombosis during their pregnancies.- - - - - - - - - - ranking = 2.5keywords = pregnancy (Clic here for more details about this article) |
9/43. A case of pregnancy with a history of paradoxical brain embolism.brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
10/43. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient.PURPOSE: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation. Clinical features: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths x min(-1), blood pressure 110/70 mmHg, pulse 120 beats x min(-1) and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody. CONCLUSION: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.- - - - - - - - - - ranking = 0.047846182626295keywords = gestation (Clic here for more details about this article) |
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