NR International Normalized Ratio

Nonpharmacologic Thrombectomy

Most cases of VTE can be successfully treated with anticoagulation. In some cases, removal of the occluding thrombus by surgical intervention may be warranted. Surgical or mechanical thrombectomy can be considered in patients with massive iliofemoral DVT when there is a risk of limb gangrene due to venous occlusion. The procedure can be complicated by recurrence of thrombus formation. In patients who present with massive PE, pulmonary embolectomy can be performed in emergency cases when conservative measures have failed. Patients who are hemodynamically unstable and have a contraindication to thrombolysis are candidates for pulmonary embolectomy. Administer heparin by IV infusion to achieve a therapeutic aPTT during the operation and postoperatively. Thereafter, give warfarin for the usual recommended duration.17,23

Vena Cava Interruption

IVC interruption is indicated in patients with PE who have a contraindication to anticoagulation therapy and in patients who have recurrent VTE while taking anticoagulation therapy.17' IVC interruption is accomplished by inserting a filter through the internal jugular vein or femoral vein and advancing it into the IVC using ultrasound or fluoroscopic guidance. IVC filters reduce the short-term risk of PE, but this benefit is not sustained in the long term. The incidence of DVT at 1 year after IVC filter insertion is higher when compared to patients without filters. Survival after a PE is

no different in patients with filters versus patients without filters. Therefore, anticoagulation therapy should be resumed as soon as possible after filter insertion and

continued as long as the filter is in place due to the high risk of DVT. Temporary or removable filters are now increasingly used and are replacing the use of permanent filters.17

Table 10-10 Vitamin K Content of Select Foods3

Very High

Low

(Greater Than

High

Medium

(Less Than

200 meg}

(100-200 meg)

{S0-100 mtg)

50 meg)

Brussels sprouts

Gasii

Apple, green

Apple, red

Chickpea

broccoli

Asparagus

Avocado

Collaret greens

Canofa oil

Cabbage

Beans

Coriander

Chive

Cauliflower

Breads and

Endive

Coleslaw

.Mayonnaise

grains

Kaie

Cucumber

Mh:,;( I- os

Carrot

Lettuce, red

(uopeeled)

Squash,

Celery

leaf

Green onion/

summer

Cereal

Parsley

stallion

Coffee

Spinach

Lettuce,

Corn

Swiss chard

butterhead

Cucumber

Tear black

Mustard greens

(peeled)

Tear green

Soybean oil

Dairy

Turnip greens

products

Watercress

Fruit (varies) Lettuce, iceberg Meats, fish, poultry Pasta Peanuts Peas Potato Rice Tomato

13Approximate amount of vitamin K per 100 g (3-5 07) serving.

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