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A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
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Thromboembolism in Older Adults.

Peter L Gross1, Noel C Chan1

  • 1Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada.

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Summary

Anticoagulant therapy is crucial for preventing blood clots in older adults but carries higher risks. This review examines managing anticoagulation with vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (DOACs) in the elderly.

Keywords:
COVID-19atrial fbrillationdirect-acting anticoagulantfalls among older adultsvenous thomboembolismvitamin K antagonist (VKA)

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Area of Science:

  • Geriatrics
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Arterial and venous thromboembolism incidence increases with age.
  • Anticoagulant therapy is essential for thromboembolism prevention but requires careful risk-benefit assessment.
  • Elderly individuals face heightened risks of both anticoagulant-related bleeding and thrombosis.

Purpose of the Study:

  • To review the challenges in implementing and managing anticoagulant therapy for older patients.
  • To compare the use of vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (DOACs) in the elderly population.

Main Methods:

  • Literature review focusing on anticoagulant use in older adults.
  • Analysis of risks and benefits associated with VKAs and DOACs in geriatric patients.

Main Results:

  • Older adults present unique challenges for anticoagulation management.
  • The choice between VKAs and DOACs necessitates a nuanced approach considering individual patient factors and risks.

Conclusions:

  • Effective anticoagulation in the elderly requires careful balancing of bleeding and thrombotic risks.
  • The evolving landscape of anticoagulants, including DOACs, offers new options but demands tailored management strategies for older patients.