Ms. Brown is a 80 year old woman with a history of atrial fibrillation and mitral mechanical valve replacement who underwent wide local excision of a right nipple-areolar complex squamous cell carcinoma and primary closure 2 weeks ago. She was discharged home on Lovenox as a bridge to warfarin for anticoagulation given the history of a mechanical mitral valve. She is now presenting after a fall while anticoagulated on lovenox and warfarin.
What are some medications may increase risk of falls in the elderly population?
Select all that applyExpand all answers
Antidepressants | |
Sedatives and anxiolytics | |
Hypoglycemic medications | |
Antihypertensives | |
Acetaminophen | |
Anticoagulants | |
Anticholinergics | |
In terms of a more detailed history, after Ms. Brown received a wide local excision of the squamous cell carcinoma 2 weeks ago, she was discharged home. About a week ago, she noticed intermittent weakness while standing for prolonged periods of time. She also noticed increased pain and swelling of her right breast, and some sanguinous oozing of the nipple. Yesterday night, she fell and developed a hematoma over her breasts. She reported to her local ED, where her INR at that time was 1.9. Her hemoglobin was found to be 7.9, down from 12.0 the day prior. At her local ED she received 5mg of IV vitamin K and 1 unit of blood and was transferred to UMHS for further management.
When is Vitamin K indicated for a patient?
Select all that applyExpand all answers
INR 4.5-10 without bleeding | |
INR >10 without bleeding | |
INR <4.5 without bleeding | |
Clinically significant, life threatening bleeding | |
Urgent surgery or procedure | |
Superwarfarin poisoning (rat poisoning) | |
How long does it take INR to correct when giving a patient IV Vitamin K?
Expand all answers
within minutes | |
within hours | |
within days | |
within weeks | |
How long does it take INR to correct when giving a patient oral Vitamin K?
Expand all answers
within minutes | |
within hours | |
within days | |
within weeks | |
Thus, in patients undergoing life-threatening bleeding, it is appropriate to choose IV Vitamin K over oral Vitamin K for faster correction of INR. Ms. Brown was given IV Vitamin K by the outside hospital for her bleed, even though her INR (1.3) was not supratherapeutic. If a patient requires more than one or two days of Vitamin K to correct INR, impaired absorption of an oral preparation should be suspected. (This does not apply in our case.)
Ms. Brown is a 80 year old woman with a history of atrial fibrillation and mitral mechanical valve replacement who underwent wide local excision of a right nipple-areolar complex squamous cell carcinoma and primary closure 2 weeks ago. She was discharged home on Lovenox as a bridge to warfarin for anticoagulation given the history of a mechanical mitral valve. She is now presenting after a fall while anticoagulated on lovenox and warfarin.
What are some medications may increase risk of falls in the elderly population?
Select all that applyExpand all answers
Antidepressants | |
Sedatives and anxiolytics | |
Hypoglycemic medications | |
Antihypertensives | |
Acetaminophen | |
Anticoagulants | |
Anticholinergics | |
In terms of a more detailed history, after Ms. Brown received a wide local excision of the squamous cell carcinoma 2 weeks ago, she was discharged home. About a week ago, she noticed intermittent weakness while standing for prolonged periods of time. She also noticed increased pain and swelling of her right breast, and some sanguinous oozing of the nipple. Yesterday night, she fell and developed a hematoma over her breasts. She reported to her local ED, where her INR at that time was 1.9. Her hemoglobin was found to be 7.9, down from 12.0 the day prior. At her local ED she received 5mg of IV vitamin K and 1 unit of blood and was transferred to UMHS for further management.
When is Vitamin K indicated for a patient?
Select all that applyExpand all answers
INR 4.5-10 without bleeding | |
INR >10 without bleeding | |
INR <4.5 without bleeding | |
Clinically significant, life threatening bleeding | |
Urgent surgery or procedure | |
Superwarfarin poisoning (rat poisoning) | |
How long does it take INR to correct when giving a patient IV Vitamin K?
Expand all answers
within minutes | |
within hours | |
within days | |
within weeks | |
How long does it take INR to correct when giving a patient oral Vitamin K?
Expand all answers
within minutes | |
within hours | |
within days | |
within weeks | |
Thus, in patients undergoing life-threatening bleeding, it is appropriate to choose IV Vitamin K over oral Vitamin K for faster correction of INR. Ms. Brown was given IV Vitamin K by the outside hospital for her bleed, even though her INR (1.3) was not supratherapeutic. If a patient requires more than one or two days of Vitamin K to correct INR, impaired absorption of an oral preparation should be suspected. (This does not apply in our case.)