A Case Study On Deep Vein Thrombosis.pptx

It contains a detailed description of the disease and case study

1. A case presentation on Deep Vein Thrombosis PRESENTED BY: P J Hemanth Reddy Pharm.D VIth year 19Y02T0018 CESCOP

2. Definition,Epidemiology, Etiology 01 Introduction Process of disease occurrence 02 Pathophysiology Signs and symptoms 03 Clinical presentation Identification of disease 04 Diagnosis Pharmacotherapy// non- Pharmacotherapy 05 Management 06 Prevention Contents of D isease

3. Deep vein thrombosis (DVT) is a serious medical condition characterized by the formation of blood clots within the deep veins of the body, typically in the legs. These clots can obstruct proper blood flow, leading to various complications such as pulmonary embolism if they break loose and travel to the lungs. The development of DVT is often associated with factors such as prolonged immobility, surgery, trauma, or certain medical conditions that increase blood clotting risk. INTRODUCTION

4. Incidence of DVT is underestimated due to diagnostic limitations; approximately 80 cases per 100,000 population occur annually, with 1 in 20 individuals developing DVT in their lifetime. In the United States, DVT accounts for around 600,000 hospitalizations per year.Elderly individuals have a four-fold increased incidence of DVT, with an in-hospital case-fatality rate of 12%, rising to 21% in this population. In hospitalized patients, the incidence of venous thrombosis ranges from 20-70%. DVT predominantly affects individuals over 40 years old, with the incidence increasing with age in both sexes. EPIDEMIOLOGY

5. EPIDEMIOLOGY Stasis of blood flow Endothelial injury Immobility Hypercoagulable Surgery/Trauma Age (>40 years) Obesity Smoking

6. PATHOPHYSIOLOGY Vessel trauma stimulates the clotting cascade DEEP VEIN THROMBOSIS Damage Damage to the intimal linings of blood vessels creates a site for clot formation Phlebitis Formation of a thrombus frequently accompanies phlebitis, which is an inflammation of the vein walls Reduced Blood flow Venous stasis occurs when blood flow is reduced, when veins are dilated and when skeletal muscle contraction is reduced RBC are trapped in the fibrin meshwork Platelets and fibrin form the initial clot Platelets aggregate at the site particularly when venous stasis present

7. CLINICAL PRESENTATION Pain in back of knee Leg pain that worsens when bending the foot Warmth Leg cramps, often starting in the calf Bluish or whitish skin discoloration Swelling Pain in lower limbs Redness Homans sign Palpable veins

8. D-dimer blood test: D-dimer is a type of protein produced by blood clots. Almost all people with severe DVT have increased blood levels of D dimer. A normal result on a D-dimer test often can help rule out PE. Duplex ultrasound: This noninvasive test uses sound waves to create pictures of how blood flows through your veins. It’s the standard test for diagnosing DVT. Venography: A dye is injected into a large vein in your foot or ankle. An X-ray creates an image of the veins in your legs and feet, to look for clots. The test is invasive, so it’s rarely performed. Other tests, such as ultrasound, often are done first. Magnetic resonance imaging (MRI abdomen): This test may be done to diagnose DVT in veins of the abdomen. Other test: Bleeding time, clotting time, INR ratio, ESR value and WBC count DIAGNOSIS

9. MANAGEMENT Tissue plasminogen activators : Alteplase 100 mg IV Reteplase 10 IU IV bolus Streptokinase 100000 IU Urokinase 4400 IU /kg IV Anti coagulants Warfarin 2-6mg ( monitor INR ratio ) Heparin 17-20 IU /kg Enoxaparin 20-40 mg s/c Direct thrombin inhibitors Argatroban 25 mg/ kg Lepirudin 0.5 microgram per kg Antiplatelets Aspirin 75- 300 mg Clopidogrel 75mg Dipyridamole 150-300 mg Factor Xa inhibitors Fondaparinux 2.5mg

10. PATIENT CASE DATA

11. A 42 years old male patient was admitted in male medical ward with IP No:15782 under the consultant doctor Dr.K.Vidya Sagar M.D, with chief complaints of Swelling of right lower limb since 10 days - insidious onset, gradually progressive, Cramping pain and swelling aggravated. And he also had H/O Trauma three years back with Hydrocele surgery 16 years back. The personal History & Habits shows Mixed diet , Normal Sleep , Normal appetite , Regular Alcoholic & Smoker , and with Regular Bowel & Bladder habits with no significant Family history . SOAP NOTES DEMOGRAPHIC DATA SUBJECTIVE EVIDENCE Patient name: xxxxxx Gender: Male Age: 42 years IP.no: 15782 DOA: 24/03/2024 Department: MM-7 Consultant Doctor: Dr. K. Vidya sagar M.D

12. SOAP NOTES OBJECTIVE EVIDENCE ASSESSMENT: Based on Subjective and Objective evidence the patient was diagnosed to with Deep Vein Thrombosis. Doppler Imp : Echogenic thrombus Located in deep popliteal vein of the right lower Limb Prothrombin time 15.2 sec INR 1.24 Sr. Homocysteine 32 mmol/L

13. PLANNING S.No Brand Name Generic Name Indication Dose ROA Frequency Duration 1. Inj. Lomorin Enoxaparin Anticoagulant 60mg S/C BD D1 to D5 2. inj. Ceftriaxone Ceftriaxone Antibiotic 1gm IV BD D1 to D5 3. Inj. Rantac Ranitidine Antisecretory 50mg IV BD D1 to D3 4. Tab. PCT Paracetamol NSAID 500mg PO QID D1 to D5 5. Tab. Chymoral forte Chymotrypsin Anti-inflammatory 1 Lakh units PO TID D1 to D5 6. Tab. B-Complex B-Complex Vitamin supplements —-- PO OD D1 to D5 7. Inj. Tramadol Tramadol Analgesic 100mg IV SOS D1 to D5 8. Tab. Pantop Pantoprazole Antisecretory 40mg PO OD D4 to D5 9. Tab. Homocheck Folic acid, vit- B6, B12 Iron & Vitamin supplements —--- PO BD D4 to D5

14. PROGRESS CHART Prognosis Treatment Day-1 24/3/2024 O/E Patient - C/C PR - 108 bpm RR- 20 cpm BP- 130/90 mm/Hg P/A- Soft CVS- S1S2 + RS- B/L BAE + 🔺 Deep Vein Thrombosis Rx Inj. Lomorin 60 mg S/C BD 1-0-1 Inj. Ceftriaxone 1 gm IV BD 1-0-1 Inj.Rantac 2cc IV BD IVF 2 NS with multivitamin @ 80 ml/hr Tab. PCT 500mg PO QID Tab. Chymoral forte PO TID Tab. B-Complex PO OD 0-1-0 INJ. Tramadol 2 ampules in 100 ml NS IV SOS. Day-2 25/3/2024 O/E Bp: 130/80 mm/Hg Remaining all vitals are normal Rx. Continue same treatment

15. PROGRESS CHART Prognosis Treatment Day-3 26/3/2024 No fresh complaints O/E Bp: 120/80 mm/Hg PPBS: 149 mg/dl FBS: 100 mg/dl Remaining all vitals are normal Rx. Continue same treatment Day-4 27/3/2024 No fresh complaints O/E Bp: 130/80 mm/Hg Remaining all vitals are normal Rx. Continue same treatment Add Tab. Pantop 40 mg PO OD Tab. Homochek PO BD 1-0-1 Stop: Inj. Rantac

16. PROGRESS CHART Prognosis Treatment Day-5 2 8 /3/2024 No fresh complaints O/E Bp: 120/80 mm/Hg PPBS: 135 mg/dl Remaining all vitals are normal Rx. Continue same treatment

17. MECHANISM OF ACTION Mechanism of Action ADRs MP Enoxaparin: It involves binding to antithrombin III, which enhances its ability to inhibit factor Xa and thrombin. This ultimately prevents the formation of blood clots. Bleeding, fever, Anemia Prothrombin time, clotting factor levels Ceftriaxone: It exhibit bactericidal activity by inhibition of bacterial cell wall synthesis Injection site pain diarrhoea,thrombocytosis CBP and signs of allergic reaction Ranitidine: Ranitidine reversibly inhibits the action of histamine at the histamine H2-receptors, including receptors on the gastric cells and thereby preventing gastric acid secretion. Abdominal pain, Constipation, Diarrhea, Headache endoscopic improvement , CBC

18. MECHANISM OF ACTION Mechanism of Action ADRs MP Paracetamol: Paracetamol works by inhibiting prostaglandin synthesis, primarily in the central nervous system, exerting its analgesic and antipyretic effects. Stomach pain Nausea Vomiting Fever Pain Trypsin - Chymotrypsin: It can directly degrade inflammatory mediators such as cytokines and chemokines, thereby reducing their activity. Local irritation, Allergic reaction, GI disturbances LFT, RFT, CBP, clinical response Tramadol: It Binds to mu opiate receptors in CNS causing inhibition of ascending pathways altering the perception of and response to pain also , inhibits reuptake of Norepinephrine , serotonin which also modifies pain pathway Flushing, pruritus, Constipation, nausea, vomiting , dizziness, headache Pain Improvement, hypotension, Hypoglycemia,

19. MECHANISM OF ACTION Mechanism of Action ADRs MP Pantoprazole : It covalently binds to the H+ K+ ATPase pump at the secretory surface of gastric parietal cells and inhibits the gastric acid and basal acid secretion Abdominal pain, Diarrhoea, Headache Monitor GI symptoms

20. The given treatment was found to be Rational . PHARMACIST INTERVENTION RATIONALITY DRUG INTERACTIONS Ranitidine + Tramadol = concurrent use may result in increased risk of serotonin syndrome & Tramadol exposure.

21. Deep vein thrombosis (DVT) is a condition where a blood clot forms in a deep vein, usually in the lower extremities . PATIENT COUNSELING REGARDING DISEASES REGARDING DRUGS Tab. Paracetamol 500mg should be taken 4 times a day to treat pain and inflammation. Tab. Chymoral forte should be taken thrice a day to treat inflammation, pain and swelling. Tab. B-Complex should be taken once a day as a vitamin supplements. Tab. Pantop 40 mg should be taken once a day to treat gastric irritation. Tab. Homochek should be taken twice a day as a Iron Vitamin supplements.

22. PATIENT COUNSELING Lifestyle Modifications Regular, moderate exercise such as walking or swimming to improve blood circulation. However, avoid prolonged periods of sitting or standing. Have a balanced diet rich in fruits, vegetables, and whole grains, while limiting processed foods and sugary snacks. Quit alcohol and smoking by seeking help from medical healthcare professional. Drink plenty of water, it helps to prevent dehydration, Aim for at least 8 glasses of water per day, unless otherwise advised by a healthcare professional. Wearing compression stockings to help improve blood flow in the legs and reduce swelling. Avoid tight clothing, especially around the waist and legs. Try for loose-fitting, comfortable clothing.

23. PATIENT COUNSELING Lifestyle Modifications Try to take medication regularly with regular follow ups to the concerned physician. While sitting or lying down, try to elevate the legs above heart level to reduce swelling and improve circulation.

24. Thanks! P J Hemanth Reddy