Delivering Integrated Care Management
The IHTC pharmacy and healthcare professionals interact on a daily basis at our center to maximize coordination and quality of care. Our pharmacists and physicians are on call and available 24 hours a day, seven days a week.
The IHTC pharmacy and healthcare professionals effectively coordinate ongoing care by proactively communicating with our patients to manage clotting factor needs, therapy compliance, and bleeding episodes.
- Individuals with multiple risk factors or triggers for thrombosis, such as resistance to activated protein C and an acquired condition, or two inherited thrombophilic disorders are at increased risk of thrombosis compared to singularly affected individuals and warrant special consideration. It is therefore reasonable to perform a complete evaluation on patients who present with their first or recurrent episodes of thromboembolic disease, especially those who present in childhood.
- APC resistance leads to a dramatically increased risk of thrombosis associated with pregnancy or estrogen-containing oral contraceptives. Because of the high frequency of APC resistance in the general population, the frequency of homozygous deficient patients may be 1:5,000.
- Warfarin (Coumadin®) should not be used during pregnancy due to its teratogenic effect.
- Before becoming pregnant, any woman with antiphospholipid syndrome considering pregnancy is advised to consult a provider who specializes in high-risk pregnancies and to consult a hematologist with knowledge in coagulation. Patients with a history of recurrent spontaneous abortions may be placed on intravenous (IV) or subcutaneous heparin and/or oral aspirin during that time that conception is attempted or during pregnancy to prevent miscarriage due to clotting of the placental blood vessels.
- In patients with heparin-induced thrombocytopenia (HIT), the platelet count should begin to recover in 2 to 5 days once all heparin is discontinued. Despite the discontinuation of the heparin, however, the patient is at continued high risk of HIT-related thrombosis for the next 30 days, and alternate anticoagulation is often required, depending on the patient’s clinical circumstances. Use of oral anticoagulation with Coumadin® alone is contraindicated in this entity due to the high risk for development of warfarin-induced skin necrosis and venous limb gangrene.