Dic

I am a nursing student in my 4th semester and OB rotation. Today I had a pt. who had had a history of DIC with her last pregnancy in '07 (spontaneous abortion). In her chart it stated that she was on prophylactic Lovenox and ASA 81 mg to prevent DIC from occuring in this pregnancy. I have a pretty good understanding of DIC, but I am just not sure of the rationale of keeping the pt. on these meds longterm... can someone help please

had a pretty young dialysis patient who ended up with this.

DIC is a horrible thing

I had a young girl recently with a ruptured AVM (previously undiagnosed). She was declared brain dead right away but the family would not give up hope so she was there for three days. Befor eshe passed away, the doctors said she was in the early stages of DIC (basd on her lab values..she was not yet bleeding out). After day two her brain eventually herniated, blood pressure dropped, and she began experienceing wide QRS complexes. She was defibrillated and went into asystole and death was declared. She was the first patient i have ever taken care of that was that sick ( i am in my last semester and i was in a preceptor assignment). I was expectant all day that she would die, seeing as how we were at the bedside all day titrating levo, dopamine and nitroprusside. She also went into pulmonary edema and her ventilator tubing was filling with blood faster than we could change it. Suctioned allllll day. Lungs totally wet, pupils blown at 9mm and unresponsive( pupils and everything else). It was a horrible situation made worse because they family couldnt accept the death and couldt make the choice to take her off support. I was amazed at how accepting the they were of her death, because she had died on her own, without them pulling the support themselves. She passed away an hour after i left that night.

I searched "thromboprophylaxis and pregnancy" and got lots of hits.

Basically pregnancy itself can be thrombophilic, and in a patient with past history of a thrombotic/coagulation disorder, prevention is better than cure. I think the patient wouldn't be on the drugs longterm, just with the new pregnancy?

(not my primary area of expertise, but I think this is right).

Yep, usually not on long-term, I know this from experience. The wife has a thrombophilia, discovered after a placental abuption. The docs said there was no need for long-term anti-coagulation, but for anti-coagulation (lovenox or heparin) during pregnancy. She was also on Coumadin post-delivery.

Tom