Clinical Case Database / Category: Prescribing
The Use of heparins for the treatment of pulmonary embolism
Publication details
Gunjan Varma MPharm, ClinDip, Manisha Madhani, Dr Peter K MacCallum, MD, FRCP, FRCPath
Foundation Years Journal, volume 2, issue 8, p.6 (123Doc Education, London, October 2008)
Abstract
Mrs VT has been brought in to A&E by ambulance following collapse after sudden onset of shortness of breath and chest pain. She has a past medical history of COPD. She is found to be tachycardic, hypotensive and peripherally shut down. Her left leg is signifiantly swollen. A 12 lead ECG reveals a sinus tachycardia with t-wave inversion in the precordial leads. CXR demonstrates changes consistent with COPD only. You suspect a massive pulmonary embolism (PE) and request an urgent computed tomography pulmonary angiogram (CTPA).
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Authors
Gunjan Varma MPharm, ClinDip (Corresponding author)
Anticoagulation Pharmacist
Barts & The London NHS Trust
Royal London Hospital
London E1 1BB
gunjan.varma@bartsandthelondon.nhs.uk
Manisha Madhani
Senior Anticoagulation Pharmacist
Barts & The London NHS Trust
Royal London Hospital
London E1 1BB
Dr Peter K MacCallum, MD, FRCP, FRCPath
Senior Lecturer and Honorary
Consultant Haematologist
Barts and the London School of Medicine and Dentistry and Barts and The London NHS Trust
Department of Haematology
St Bartholomew’s Hospital
London EC1A 7BE
References
1. BTS Guidelines for the Management of Suspected Acute Pulmonary Embolism, 2003. The British Thoracic Society Standards of Care Committee, Pulmonary Embolism Guideline Development Group. Thorax, 2003, 48:470–484.
2. Kearon C, Kahn SR, Giancarlo A, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edn). Chest, June 2008, S454–S545.
3. Guidelines on the use and monitoring of heparin. British Journal of Haematol, 2006, 133(1):19–34.
4. The management of heparin induced thrombocytopenia. British Journal of Haematol, 2006, 133(3):259–269.
5. Summaries of Product Characteristics: Heparin sodium 1000IU/ml ampoule, solution for infusion (Leo Laboratories Ltd), last updated on 20 December 2007.
6. British National Formulary No. 56, March 2009.
7. Rashke RA. The Weight-based Heparin Dosing Nomogram Compared with a “Standard Care†Nomogram. Annals of Internal Medicine, 1993, 119:847–881.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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