CASE PRESENTATION OF DVT

(DEEP VEIN THROMBOSIS)

Prem Patel
Enrolment No : 192060888022
Pharm - D 4th Year
Introduction :

• Deep vein thrombosis is a part of a condition

called venous thromboembolism.
• Deep vein thrombosis occurs when a blood clot
(thrombus) forms in one or more of the deep
veins in the body, usually in the legs.
• Deep vein thrombosis can cause leg pain or
swelling, but may occur without any symptoms.
• Deep vein thrombosis is a serious condition
because blood clots in the veins can break loose,
travel through the bloodstream, and obstruct the
lungs, blocking blood flow.
Sign and Symptoms
• Edema
• Tenderness
• Swelling and pitting edema
• Painful leg
• Increased skin temperature and fever
Pathophysiology
 Risk Factor

• Prolonged bed rest

• Injury or Surgery
• Obesity
• Age
• Birth control pills
• Heart failure
• Family history
 Diagnosis

• Doppler ultrasound : The tip of the Doppler transducer is

positioned at a 45- to 60-degree angle over the expected
location of the artery and angled slowly to identify arterial
blood flow.

• Computed tomography : Computed tomography provides

cross-sectional images of soft tissue and visualizes the area
of volume changes to an extremity and the compartment
where changes take place.
• Blood test : Almost all people who develop severe deep
vein thrombosis have an elevated blood level of a clot-
dissolving substance called D dimer.

• Venography : A dye (contrast agent) is injected into a large

vein in your foot or ankle. An X-ray procedure creates an
image of the veins in your legs and feet, to look for clots.
However, less invasive methods of diagnosis, such as
ultrasound, can usually confirm the diagnosis.
Case Presentation
 SUBJECTIVE DATA

Age :- 37 Year
Sex :- Male
Date of admission :-7/02/2023
Date of discharge :- 11/02/2023

Complain of admission :
- Inability to walk
- Bursting pain
- Leg Swelling
Family History :
F/H/O = History of Hypertension of his father.

Social History:
Diet= Mixed
Smoking= Quit before 3 year
Alcohol = for past 10 year

Patient has no medical and medication history

 Provisional Diagnosis
• Edema
• Deep Vein Thrombosis
 OBJECTIVE DATA
General Examination:
Pulse rate = 80 bpm
BP = 126/84 mmHg
CNS = Conscious and Oriented
CVS = S1S2 +
RS = BAE +
PA = Soft and non tender

Physical Examination :
Pedal edema +
 LABORATORY DATA

PARAMETER OBSERVED VALUE NORMAL VALUE

Hb 13.3 gm/dl 12-16 gm/dl
WBC 6400 4000-11000
Platelet count 4,03,000 1.5 L – 3L
ESR 60 mm/hr 0 -20 mm/hr
RBS 94 mg/dl 80 -120 mg/dl
HBA1C 5.1 % < 6.5 %
Sr. Creatine 1.2 mg/dl 0.7-1.4 mg/dl
Sr. Uric acid 4.7 mg/dl 2.5 – 7 mg/dl
Urine analysis
Color Pale yellow
Reaction Acidic
Appearance clear
Pus cell 1-2/HPF 0-5/HPF
Epithelial cell 0-2/HPF 0-5/HPF

Other Investigation :
Color doppler: Superficial deep vein thrombosis of lower veinous
system.
D-Dimer : 578.4 ng/ml
Bleeding time: 1-5 min
Clotting time: 3-6 sec
 Final Diagnosis :

DEEP VEIN THROMBOSIS

Problem list
• Pain
• Swelling
• Unable to walk
• Edema

Goals of therapy :
NAID
Anticoagulant
Diuretics
Low molecular wt. heparin ( Enoxaparin)
 CURRENT THERAPY

Sr. No Drug name Dose Route of Freq Day 1 Day 2 Day 3 Day 4 Day 5
Admini (7/02) (8/02) (9/02) (10/02) (11/02)

1 Enoxaparin O.6 ml SC BD    

2 Warfarin 4 mg Oral 0-1-0     

3 Ranitidine 150 mg Oral 1-0-1   

4 Dicolfenac 50 mg Oral 1-0-1     

5 Furosemide 40 mg Oral OD     
 Current therapy

1. Inj Enoxaperin
Dose : 0.6 ml prefilled syringe
Frequency : BD
Route of Administration : SC
Class : Low molecular wt. Heparin
MOA :- Enoxaparin binds to antithrombin III, a serine protease
inhibitor, forming a complex that irreversibly inactivates factor
Xa, which is frequently used to monitor anticoagulation in the
clinical setting.
ADR : Bleeding in urine , Bleeding from teeth,
Drug – Drug interaction : Aceclofenac The risk or severity of
bleeding and hemorrhage can be increased when Aceclofenac is
combined with Enoxaparin.
2. Warfarin
Dose:- 4 mg
Frequency : 0-1-0
Class :- Oral anticoagulant
Route of administration : oral
MOA : Warfarin is a [vitamin K] antagonist which acts to inhibit the
production of vitamin K by vitamin K epoxide reductase. The reduced
form of vitamin K, vitamin KH2 is a cofactor used in the γ-
carboxylation of coagulation factors VII, IX, X, and thrombin.
ADR :Severe bleeding, Red or brown urine. Black or bloody stool.
Severe headache or stomach pain.
Drug – Drug interaction :
Aceclofenac The risk or severity of bleeding and hemorrhage can be
increased when Aceclofenac is combined with Warfarin.
Abacavir Abacavir may decrease the excretion rate of Warfarin
which could result in a higher serum level.
3. Diclofenac
Dose :- 50 mg
Frequency :- 1-0-1
Route of administration :- Oral
Class :- NSAID
MOA :- inhibition of prostaglandin synthesis by inhibiting
cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) with
relative equipotency.
ADR : stomach ache. feeling or being sick (vomiting), diarrhea.
Indication : use to treat pain
Drug-Drug interaction : Abacavir Diclofenac may decrease the
excretion rate of Abacavir which could result in a higher serum level
4. Ranitidine
Dose :- 150 mg
Frequency :- 1-0-1
Class : - H2 blockers
Route of administration :- Oral
MOA :- Ranitidine is a competitive inhibitor of histamine H2-receptors.
The reversible inhibition of H2-receptors in gastric parietal cells results in
a reduction in both gastric acid volume and concentration.
ADR : headache. constipation. diarrhea. nausea. Vomiting
Drug – Drug interaction :
Acebutolol The metabolism of Acebutolol can be decreased when
combined with Ranitidine.
Indication :- treatment and prevention of ulcers of the stomach and
intestines and treatment of gastroesophageal reflux disease.
5. Furosemide
Dose :- 40 mg
Frequency :- OD
Route of administration :- oral
Class :- Diuretics
MOA :- furosemide promotes diuresis by blocking tubular reabsorption of
sodium and chloride in the proximal and distal tubules, as well as in the thick
ascending loop of Henle. This diuretic effect is achieved through the
competitive inhibition of sodium-potassium-chloride cotransporters
(NKCC2) expressed along these tubules in the nephron, preventing the
transport of sodium ions from the lumenal side into the basolateral side for
reabsorption. This inhibition results in increased excretion of water along
with sodium, chloride, magnesium, calcium, hydrogen, and potassium ions.
Indication :- Oral furosemide is indicated alone for the management of mild
to moderate hypertension or severe hypertension in combination with other
antihypertensive medications and treatment of edema.
 Discharged prescription

Medication :
Tab. Warfarin 4 mg 0-1-0
Tab. Ranitidine 150 mg 1-0-1
Tab. Diclofenac 50 mg 1-0-1

Advice :
Review after 7 days
 Pharmacist intervention

• Patient was given discharge prescription without further test

• Patient wasn’t check for blood pressure after administration
of furosemide
 Monitor Closely

enoxaparin + diclofenac
enoxaparin and diclofenac both increase anticoagulation. Modify
Therapy/Monitor Closely.

diclofenac + warfarin
diclofenac, warfarin. Either increases effects of the other by
pharmacodynamic synergism. Modify Therapy/Monitor Closely.
Drugs with antiplatelet properties may increase anticoagulation effect
of warfarin.

diclofenac + furosemide
diclofenac increases and furosemide decreases serum potassium.
Effect of interaction is not clear, use caution. Use Caution/Monitor.
 Minor

diclofenac + furosemide
diclofenac decreases effects of furosemide by pharmacodynamic
antagonism. Minor/Significance Unknown. NSAIDs decrease
prostaglandin synthesis.
 PATIENT COUNSELLING
1) Disease related

• Patient is told about the condition and the complications of it.

• Patient is also told that the condition is chronic and may worsen if
not managed properly.
2) DRUG BASED COUNSELLING:

• WARFARIN: After administering warfarin if patient suffer from

bleeding Of gums, blood in urine, nose bleeding report to physician
• immediately.
• DICLOFENAC: It is a drug taken to relieve pain and take this drug
when you experience leg pain.
• RANITIDINE: should be taken half an hour before the meal .
3 ) LIFESTYLE MODIFICATIONS

• Patient was advised to include salt less foods.

• Patient was advised to avoid fatty foods
• Patient was advised to reduce vitamin k foods during therapy.
• Pineapple contains bromelain reduces the risk of clot formation
in blood vessels.