Abstract: . . .  is necessary in up to 25% of patients, and mortality ap- proaches 25% to 30% (see Chapter 87, Drug-Induced Blood Disorders). 22 In patients who develop type II HIT, heparin therapy should be stopped immediately and treatment with an alterna- tive anticoagulant should be initiated. 7 Although associated with a lower risk of type II HIT than UFH, LMWH products are contraindicated in patients with type II HIT because of a high incidence of immunologic cross-reactivity with hep- arin. 24 Preferred options include argatroban, a synthetic direct thrombin inhibitor, and lepirudin (Refludan), a recombinant form of the direct thrombin inhibitor . . .
. . .  of DVT is unilateral leg swelling that often is ac- companied by local tenderness or pain. 17 A tender, cordlike entity caused by venous obstruction sometimes can be pal- pated in the affected area. L.N. presented with the sudden on- set of swelling along with soreness, but without evidence of a cord. Discoloration of the affected limb, including pallor from arterial spasm, cyanosis from venous obstruction, or a reddish color from perivascular inflammation, also may occur. The presence or absence of a positive Homans sign (pain behind the knee or calf upon dorsiflexion of the foot) rarely is help- ful in making the diagnosis because it is present in only about 30% of patients . . .
. . .  by aspirin With prior history systemic embolism 2.5 (2.03.0) 312 months Followed by aspirin With atrial fibrillation 2.5 (2.03.0) chronic Following systemic embolism 2.5 (2.03.0) chronic Add aspirin Continued Koda-Kimble_Ch16_001-034 4/6/04 8:42 AM Page 7 Page 8 DEEP VENOUS THROMBOSIS Clinical Presentation Signs and Symptoms 1. L.N., a 76-year-old, obese (92 kg, 6 ft tall) man, was ad- mitted to the hospital 3 days ago for management of recurrent angina. He was started on a nitroglycerin drip and confined to bed rest with gradual increases in his oral antianginal medica- . . .
. . .  such as urticaria, rash, rhinitis, conjunctivitis, asthma, and angioedema, as well as a reversible temporal alopecia. 5 ADJUSTED-DOSE SUBCUTANEOUS ADMINISTRATION 13. By day 4 of heparinization, IV access for L.N. has become difficult. What alternatives can be considered? The most common strategy for treatment of venous throm- bosis in hospitalized patients without IV access is the use of SC LMWH (see Question 15). Another alternative is SC ad- ministration of unfractionated heparin with adjustment of dosing to maintain a therapeutic aPTT. 29 Typically, SC heparin is administered at 12-hour intervals and aPTT is monitored at the mid-dosing . . .
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