q 1 - monicamukerji

[ArchivalUser]

A previously healthy 54-year-old man is admitted to the intensive care unit with severe community acquired pneumonia. He is endotracheally intubated and is receiving mechanical ventilation. He has a right subclavian vein catheter, through which he is receiving antibiotics, vasopressors, analgesia, and sedation.

His temperature is 38 °C (100 °F), blood pressure is 110/70 mm Hg and heart rate 110/min on his current dose of vasopressors.

Which of the following is the most appropriate prophylaxis for venous thromboembolism in this patient?

A Warfarin adjusted to an INR of 2.0-3.0
B Low-dose heparin or low-molecular-weight heparin
C Aspirin
D No prophylaxis required

[ArchivalUser]

DD

[ArchivalUser]

i also answered D BUT THE ANS IS COMING IN 5 MIN

[ArchivalUser]

Correct Answer = B)
Key Points

* Unfractionated and low-molecular-weight heparins reduce the risk of clinically important venous thromboembolism in critically ill patients by up to 60%.
* Aspirin has not been shown to reduce the incidence of thromboembolism in most populations at risk.

Venous thromboembolism occurs in 13% to 30% of patients in intensive care who have not received prophylaxis. Heparin and dalteparin and other low-molecular-weight heparins have been shown in large clinical trials to reduce the risk of clinically important venous thromboembolism in critically ill by patients by up to 60%. These agents are highly recommended for patients at moderate or high risk for venous thromboembolism.

Warfarin, especially at œtherapeutic doses, is not recommended for prophylactic use in medical patients. Its long duration of action may be especially detrimental in patients in the intensive care unit, who may need multiple invasive procedures. Aspirin is not commonly recommended for the prevention of venous thromboembolism, and has not been demonstrated by clinical trials to reduce the incidence of thromboembolism in most populations at risk.

[ArchivalUser]

thanx drmonicamukerji