ChiefProton832
Week 10 Case Studies: Anticoagulants and Antiplatelets Case Study…
Week 10 Case Studies: Anticoagulants and Antiplatelets
Case Study 1: Deep Vein Thrombosis
Jennie, a 38-year-old businesswoman, develops a red, swollen, and tender left leg following a long flight
to Europe. She denies any recent injury or fevers and her general health has been unremarkable.
She unfortunately contracted a viral infection 3 weeks ago which was later diagnosed as COVID-19. She
was unwell in bed with the viral illness for 3 days.
Due to increased pain and swelling of the leg, she decided to visit a local hospital for assessment of her
condition.
SHx: lives in Salt Lake City, 2 children and married
Med Rec: Combined oral contraceptive daily, Acetaminophen and Naprosyn PRN for tension headaches
FHx: Brother had deep vein thrombosis (DVT)
PMHx: Recently started smoking (6 months ago), recent immobility due to viral illness
1) Compare and contrast the mechanism of action of antiplatelets, anticoagulants, and thrombolytic
medications. [3 points]
2) List 2 indications each for antiplatelets, anticoagulants, and thrombolytic medications. [3 points]
3) Which medication or combination of medications would you recommend for treating Jennie’s
condition? Give a brief rationale for your answer. [2 points]
4) List 2 common adverse effects associated with each of the following medications: [4 points]
a) Heparin
b) Warfarin
c) Enoxaparin
d) Apixaban
5) For the following tests, list the reference ranges for a patient who is not taking an antithrombotic
medication as well as for a patient who is taking an antithrombotic medication. In addition, indicate
which antithrombotic medication(s) the test is used to monitor. [6 points]
a) aPTT
b) INR
6) Determine the reversal agent(s) available for the following anticoagulants. [4 points]
a) Heparin
b) Warfarin
c) Dabigatran
d) Rivaroxaban
Case Study 2: Peripheral Arterial Disease
A 75-year-old man, Clive, is being treated for intermittent claudication with a combination of clopidogrel
and aspirin (acetylsalicylic acid). His leg pain has been well controlled except for when walking up steep
hills in his neighborhood.
While sitting relaxing one day, he develops severe pain and pallor to his leg, which prompts a 911 call for
an ambulance. Following an angiogram at the hospital, he is diagnosed with severe peripheral artery
disease (PAD).
PMHx: Long term smoker, hypertension, hypercholesterolemia
Med Rec: Aspirin 81mg QD, clopidogrel 75mg QD, atorvastatin 20mg HS, metoprolol succinate 25mg QD
7) List 2 medical conditions, other than peripheral arterial disease, that antiplatelet medications (e.g.
aspirin, clopidogrel) are used to treat. [2 points]
Case Study 3: Colony Stimulating Factors
An elderly woman, Estelle, is receiving chemotherapy for breast cancer. Approximately 10 days
following a dose of chemotherapy, she develops bruises, petechiae, and pale appearing skin. A CBC
(Complete Blood Count) is drawn revealing the following: Hg: 7g/dL, HCT:27%, platelets: 54,000/uL,
WBC: 1,000/uL.
8) Review the results of the CBC. List the abnormal findings. [4 points]
9) Which medication(s) can be used to stimulate red blood cell production? List at least 2 adverse
effects of this medication. [2 points]
10) Which medication(s) can be used to stimulate platelet production? List at least 2 adverse effects of
this medication. [2 points]
11) Which medication(s) can be used to stimulate white blood cell production? List at least 2 adverse
effects of these medications. [2 points]
12) Identify 2 indications for using a colony stimulating factor. [2 points]
13) Instead of using growth factors to stimulate the different cells lines in the bone marrow,
transfusions of blood products could be used in this patient. List 2 blood components that could be
administered to this patient to treat her condition. [2 points]
14) List 2 potential adverse events/reactions of administering packed red blood cells (PRBC’s). [2
points]
15) List 2 indications for IV albumin? [2 points]
Case Study 4: Heart Attack
A patient is urgently brought to a rural emergency room with severe chest pain, sweating, pallor, and
shortness of breath.
The emergency room staff apply oxygen, perform vital signs, and do an electrocardiogram (ECG) plus
take blood work for CBC, electrolytes, creatinine, and a troponin (cardiac enzyme).
Following initial testing, a STEMI (heart attack) is diagnosed. The ECG reveals ST-elevation, and the
serum troponin is elevated, indicating a heart attack.
The patient is at once given two baby aspirins (aspirin 81mg) orally and a loading dose of oral
clopidogrel. After further discussion with the patient, IV alteplase is administered, followed by an IV heparin
infusion.
16) Briefly explain why multiple blood thinners have been administered to this patient. [2 points]
17) List 4 contraindications to using alteplase. [4 points]
18) Describe at least 2 advantages of using a low molecular weight heparin (LMWH) compared to
heparin? [2 points]
