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24/12/2021 at 17:49 น. #18561Sajikapon KludkleebBlocked
Answer 3;
She can travel to South Korea after the treatment for at least 4 weeks.In this case, direct flight from Bangkok to Seoul is about 5-6 hrs. And since she has history of previous VTE, she will have risk to develop VTE again. I would recommend her to;
1) take anticoagulant regularly as prescribed – if she is taking warfarin at the time of traveling, then continues the medication as usual
2) wear loose and comfortable clothes
3) do calf exercises at least every half hour – raise your heels, keeping your toes on the floor, then bring them down 10 times, then raise and lower your toes 10 times
4) choose aisle seat and walk around whenever you can
5) use compression stockingsAnd also advice her to recognize signs and symptoms of VTE.
In case if she is planning for a long distance flight (>8hr) and already free from anticoagulants, I would recommend her to use LMWHs such as enoxaparin SC for prophylaxis for VTE during the long-haul flight.
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23/12/2021 at 19:13 น. #18548Sajikapon KludkleebBlocked
Answer 1;
Signs and symptoms
– non-pitting, warm, erythematous edema at lower extremities
– darker skin on the swelling area (Phlegmasia culerae dolens in severe case, absent distal pulse)
– tender along venous tract on the swelling leg (Homan’s sign – tender along venous tract when ankle flexion)
– may develop acute rapid pulse or fainting or dyspnea of breath if there is pulmonary embolism; in this case O2 saturation is 97% – a little bit decrease for a healthy person
– D-dimer elevation
– history of recent surgery, long-haul flights, cancer may increase risk -
24/12/2021 at 17:18 น. #18560Sajikapon KludkleebBlocked
Answer 2; The treatment of VTE can be divided into 3 distinct phases;
1) initial treatment phase (up to 10 days) aims for prevent propagation of DVT
2) principle treatment phase (first 3 months) to maintain therapeutic level of anticoagulant to prevent propagation of DVT and reduce risk of early recurrent VTE
3) extend treatment phase (beyond 3 months) with specific aims to reduce the long term risk of recurrent VTE, depends on underlying conditions and risk factorIn this case, the patient only has DVT and no evidence of pre-existing cancer. She should receive anticoagulant starting with unfractionated heparin (UHF) IV or Low molecular weight heparin (LMWHs)for at least 5 days and can be discontinued when INR level >2 for 2 consecutive days after starting of warfarin.
Warfarin should be prescribed for about 3 months and then consider to continue if she has any risk factors for VTE.
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