Needs of special populations
Download
1 / 10

Needs of Special Populations - PowerPoint PPT Presentation


  • 347 Views
  • Updated On :

Needs of Special Populations Andra H. James MD, MPH Comprehensive Hemostasis and Thrombosis Center & Department of Obstetrics and Gynecology Duke University Medical Center Special Needs of Women Contraception Birth control pills increase the risk of thrombosis 3 to 4-fold

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Needs of Special Populations' - albert


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Needs of special populations l.jpg

Needs of Special Populations

Andra H. James MD, MPH

Comprehensive Hemostasis and Thrombosis Center

&

Department of Obstetrics and Gynecology

Duke University Medical Center


Special needs of women l.jpg
Special Needs of Women

  • Contraception

    • Birth control pills increase the risk of thrombosis 3 to 4-fold

    • Patches expose women to 60% more estrogen

    • Progestin-only contraceptives do not increase the risk

  • Menopausal symptoms

    • Postmenopausal hormone therapy increases the risk of clots

    • Progestin, in doses to treat abnormal bleeding increases the risk 5 to 6-fold

  • Heavy menstrual bleeding

    • May affect half of women on anticoagulants

  • Hemorrhagic ovarian cysts


Special needs of pregnant women l.jpg
Special Needs of Pregnant Women

  • Women on warfarin must convert to heparin

  • Women with a history of thrombosis will require heparin during pregnancy and for at least 6 weeks postpartum

  • Women with thrombophilia are at risk for poor pregnancy outcome

  • Women with thrombophilia and a history of poor pregnancy outcome will likely require heparin

  • Women with thrombophilia but no history of thrombosis or poor pregnancy outcome do not require anticoagulation.


Thromboses in unborn babies l.jpg
Thromboses in Unborn Babies

  • Vascular disruptions

  • Renal veins

  • Vena cavae

  • Cerebral venous sinuses

  • Umbilical veins

  • Placental vessels


Thromboses in infants l.jpg
Thromboses in Infants

  • 80% catheter-related

    • Lines in upper body

    • Lines in umbilical vein

  • 20% spontaneous

    • Renal veins

    • Cerebral veins

  • Treat with anticoagulants or thrombolysis

  • Neonatal purpura fulminans


Special needs of children l.jpg
Special Needs of Children

  • The coagulation system changes with age

  • High circulatory demands

  • Different illnesses and different medications

  • Inability to cooperate

  • Intravenous access

  • No pediatric formulations of any anticoagulants

  • No liquid warfarin or pediatric doses of pre-filled syringes

  • Different diets and formulas contain different amounts of vitamin K

  • Different level of understanding

  • Dependent on their parents


Assembling a team to meet the needs of individuals l.jpg
Assembling a Team to Meet the Needs of Individuals

  • No specialist for venous thromboembolism

  • Community hematologists devote 90% of their time to cancer patients

  • The ideal team:

    • Expert in coagulation

    • Pharmacist knowledgeable in anticoagulation

    • Nurse to educate the patient

    • Primary provider


Assembling a team to meet the needs of families l.jpg
Assembling a Team to Meet the Needs of Families

  • Young adults and children with spontaneous DVT or PE often have thrombophilia

  • Questions arise regarding:

    • Whom to test

    • Whom to treat

  • Ideal team includes a knowledgeable genetic counselor


Creating a center that meets the needs of the community l.jpg
Creating a Center that Meets the Needs of the Community

  • Consultative services for inpatients and outpatients

  • Direct care in complex cases

  • Coagulation laboratory support

  • Educational materials for patients

  • Continuing medical education

  • Websites

  • Protocols

  • Publications


Meeting the needs of the nation l.jpg
Meeting the Needs of the Nation

  • Spyropoulos and Haire described the Clinical Thrombosis Center

  • Needs of special populations were not considered

  • In 2001, the CDC initiated a pilot program of thrombophilia centers to:

    • Determine the value of a multi-disciplinary team in providing care to persons with coagulation disorders.

    • Assess unmet needs and identify outreach strategies to improve access to care.

    • Develop effective messages aimed at disease management and prevention.

    • Foster the development of training programs to enhance provider skills.

  • 8 receiving funding, networking and modeling care