Rotation 1: It's a thin line...

Posted by Lauren Leader at Tuesday, October 07, 2014

... between bleeds and clots

MR is a 50 year old male who has had an LVAD machine since 2009. He presented to an outside hospital for management of continuous bleeding after severing a finger. The outside hospital held his warfarin and gave him a single dose of 5 mg of vitamin K, what do we do?

I spent my first rotation in ambulatory care specializing in anticoagulation. The service was a nurse run warfarin management facility with two pharmacists on staff. Pharmacists were specifically in charge of patients with LVAD (left-ventricular assist devices). These devices require more intense warfarin management due their increased risk of clotting. The majority of my time was spent monitoring patients INRs and having phone interviews to assess their regimen and make changes if necessary. The other valuable portion of this rotation was that the pharmacists on this service worked with the cardiology team to consult and follow TSOAC (target-specific oral anti-coagulants).

THIS IS SPECIAL TIME FOR PHARMACY!!

TSOACs are new medications and extremely useful medications. I was able to learn about the studies that the FDA used to approve these drugs, why one might be better for another give specific patient parameters and it was exciting to learn so in depth about something so new.

Also, on this rotation I had weekly meetings with other students on ambulatory care rotations throughout the health system. We had topic discussions, journal club meetings and case presentations which helped to increase our learning and prepare use for life-long learning opportunities in the field.

oh, the patient... almost forgot! We hardly ever give LVAD patients vitamin K since it directly inhibits the anticoagulation effects of warfarin and it is imperative that patients on LVAD machines stay anticoagulated. We gave him a two consecutive bolus doses of warfarin (one that day and one the next day) then restarted him on his previous maintenance dose. We were able to keep the patient from needing other forms of anticoagulation which was a win for everyone.