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Zorluk: KolayMonitoring and Treatment Evaluation

A 54-year-old man is admitted to the hospital with an acute, unprovoked deep vein thrombosis and a subsequent pulmonary embolism. He is hemodynamically stable and is initiated on a continuous intravenous infusion of unfractionated heparin. Which of the following laboratory parameters are essential to monitor routinely to ensure the therapeutic efficacy and safety of this specific therapy? (Select all that apply)

  1. Activated partial thromboplastin time (aPTT)Cevap
  2. B
    Prothrombin time (PT)
  3. C
    Serum creatinine
  4. Platelet countCevap
  5. E
    D-dimer

Cevap

The correct parameters to monitor are the activated partial thromboplastin time (aPTT) and the platelet count.
Unfractionated heparin binds to antithrombin, accelerating its inactivation of thrombin and factor Xa. This effect primarily prolongs the intrinsic coagulation pathway. Therefore, the activated partial thromboplastin time (aPTT) is routinely used to titrate the heparin infusion to a specific therapeutic target. Additionally, heparin can cause the formation of antibodies against the heparin-platelet factor 4 complex, leading to heparin-induced thrombocytopenia (HIT). Routine monitoring of the platelet count is essential to detect this potentially life-threatening prothrombotic complication early.

Adım Adım Çözüm

1
Identify the initiated pharmacotherapy.
The patient is receiving a continuous intravenous infusion of unfractionated heparin.
Different anticoagulants require entirely different monitoring protocols based on their mechanism of action and clearance.
2
Determine the parameter required to monitor the therapeutic efficacy of unfractionated heparin.
Activated partial thromboplastin time (aPTT) is required.
Unfractionated heparin enhances antithrombin activity, which primarily affects the intrinsic coagulation pathway. This pathway is measured by the aPTT.
3
Determine the parameter required to monitor the safety and identify specific adverse effects of unfractionated heparin.
Platelet count is required.
Heparin-induced thrombocytopenia (HIT) is a known immune-mediated complication of heparin therapy, necessitating routine platelet monitoring to ensure patient safety.

Anahtar Kavram

Patients receiving intravenous unfractionated heparin require routine monitoring of the activated partial thromboplastin time (aPTT) to ensure therapeutic efficacy, and routine monitoring of platelet counts to detect heparin-induced thrombocytopenia (HIT).
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Monitoring and Treatment Evaluation

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