pharmacotherapeutics III Case presentation on deep vein thrombosis

SCENARIO: Here is a 20 year old male patient admitted to male surgery wards and diagnosed as deep vein thrombosis and hospitalized for 6 days HISTORY OF PRESENT ILLNESS The patient is apparently alright 2 years back developed swelling of both limbs with pain H/O discoloration of both limbs since 2 months and itching SOAP NOTE SUBJECTIVE: patient complains of swelling of legs since 2 years ,pain and itching Decreased appetite OBJECTIVE ESR was elevated 20mm/hr PT was prolonged 19.2 sec(10-14 sec) CBC and urine analysis was normal.

DOPPLER varicosity of bilateral saphaneous veins and left short saphaneous vein with partially occluding thrombus within Multiple venous collaterals in thigh and pelvic region Chronic echogenic noted causing partial or total occlusion of inferior venecava and bilateral common iliac , external iliac , femoral ,superficial and deep femoral and popliteal veins.

ASSESMENT By the above subjective and objective physician diagnosed the condition as DEEP VEIN THROMBOSIS PROBLEM LIST: SWELLING OF LEGS,PAIN AND ITCHING DECREASED APETITE VARICOSE VEINS SWELLING OF LEGS ,PAIN AND ITCHING: This is due to deep vein thrombosis due to venous obstruction and venous insufficiency and swollen varicose veins DECREASED APETITE: This may be due to stress induced. DEEP VEIN THROMBOSIS: An initial manifestation of the VTE disease process in which blood clots form deep in the venous system Risk factors for VTE include cancer, surgery, immobilization, trauma, estrogen use, inherited or acquired thrombophilias , and central venous catheters .

VARICOSE VEINS: veins are swollen veins over-filled with blood VARICOSE VEINS: veins are swollen veins over-filled with blood. The blood makes them look red, blue, or purple. These veins are usually in the legs. But you may have varicose veins in other parts of the body, such as around your anus PLANNING: GOALS OF THERAPY: To subside the symptoms To enhance venous blood flow by thrombolysis To prevent secondary complications like ruptured bakers cyst,cellulitis and post phlebitic syndrome PAIN IN LEG: ACECLOFENAC 100 MG 1-0-1: This is an NSAID .Cox I inhibitor to reduce pain in legs for 6 days HEPARIN BENZYL NICOTINATE TOPICAL ON BOTH LEGS 1-0-1 For superficial thrombosis. For 5 days from day 2 LOSS OF APETITE self limiting

DEEP VEIN THROMBOSIS BEMIPARIN SODIUM 5000 IU: SC 1-0-1 for 6 days Low molecular weight heparin which has anti-Factor Xa and anti-thrombin (anti- Factor IIa) activities FOR 6 DAYS NICOUMALONE 2 MG 0-0-1: anticoagulant that works by blocking the regeneration of vitamin K(1) epoxide, thus inhibiting synthesis of vitamin K-dependent clotting factors which include factors 2, 7, 9 and 10, and the anticoagulant proteins C and S. for 5 days ASPIRIN 150 MG AND CLOPIDROGEL 75 MG Thrombosis prophylaxis for 6 days. VARICOSE VEINS: B COMPLEX AND MULTI VITAMIN SUPPLIMENTS CEFIXIME 200 MG AND DICLOXACILLIN 500 MG: As prophylaxis for hospital acquired infection RABEPRAZOLE 20 MG 1-0-0 AS PROPHYLAXIS FOR HYPERGASTRIC SECRETION INDUCED BY NSAID AND ANTIBIOTICS

Thank u DISCHARGE DRUGS: ZERODOL P SOS CAP BENEFICIALE 0-1-0 FOR 5 DAYS THROMBOPHOB OINTMENT 1-0-0 FOR 5 DAYS Thank u