Where you are
You are an FY2 in OBG.Who is the patient
Mrs. Maria Smith, aged 42, had her 4th delivery yesterday.
She has lost 1200ml of blood.Other information
No known allergy.
She has not been diagnosed with any past medical history.
Her weight is 60kg.What you must do
DVT risk assessment has been done and write down the anticoagulant according to the weight.Special note
None
Shortcut:
Regular: Dalteparin 5000 U SC 10 days.
Additional information: Review after 10 days.
Explanation 1:
- In postnatal prophylaxis see the task to assess risk like age, parity, PPH
- VTE prophylaxis chart will be given. Then see the risk category from the chart.
- Now see bottom of chart
- The drug name, dose, duration have been given.
- Here age more than 35(here age is 42]
- Parity more than 3 (it was 4 th delivery)
- Blood loss more than 1 liter (her blood loss is 1200 ml).
- There are three criteria for intermediate risk. That’s why we are giving anticoagulant for 10 days.
- In this case it’s for 10 days. Review after 10 days.
- drug of choice enoxaparin or dalteparin or tinzaparin once daily for 10 days. (Here weight is 60kg)
Explanation 2:
Firstly, using the chart we asses under which risk category the patient falls in from the postnatal section of the chart.
If the patient has two or more risk factors mentioned in the box in the chart, or other criteria as they have mentioned in chart, the patient falls in the intermediate risk category as in the scenario for whom prophylaxis should be given a minimum of 10 days. In the scenario risk factors for the patient we have are age above 35, parity >3, PPH > 1 Litre.
After assessing the risk category, we prescribe the dosage based on the patient’s weight. In the scenario, let’s say the patient weight is 60 Kg, in that case if we look at the bottom of the chart we ll be given recommendation on which medications and what dosage can be prescribed.
According to the chart also same in the BNF we have 3 options, 40 mg Enoxaparin S/C, or 5000 Units Dalteparin S/C, or 4500 Units Tinzaparin S/C all of them are once daily(usually evening).
As we have choice to prescribe one of these 3 medications, it would be easier to prescribe Dalteparin in exam as the medication is already printed in the Prescription/Kardex so we just need to write the dosage, route and dates for Dalteparin accordingly, and additional information to reassess in 10 days.
Prescribe other regular medication which are given.