title: Limb-Threatening Acute Venous Thromboembolism in a Patient Undergoing Postarrest Therapeutic Hypothermia.
abstract: Postcardiac arrest patients are at high risk for developing venous thromboembolism (VTE). Current postarrest guidelines do not provide recommendations for prevention or surveillance of VTE and there is little guidance regarding the optimal prophylaxis or treatment of VTE during therapeutic hypothermia (TH). Many patients develop acute liver dysfunction resulting from severe global hypoperfusion during cardiac arrest, compounding concerns for bleeding with the initiation of TH. However, significant VTE may occur following arrest and can contribute to additional morbidity and mortality. The pharmacokinetics of anticoagulation, the routine treatment for VTE, have not been extensively researched or tested under hypothermic conditions. Standard approaches for prevention and treatment have been utilized, such as unfractionated heparin, but their efficacy remains uncertain. This case illustrates the significant imbalance of coagulation in a postcardiac arrest patient undergoing TH.
authors.affiliation: 1 Oakland University William Beaumont School of Medicine , Rochester Hills, Michigan.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Stahl
authors.affiliation: 2 Department of Emergency Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kurz
authors.affiliation: 3 Department of Emergency Medicine, Osceola Regional Medical Center , Kissimmee, Florida.
authors.forename: Larissa
authors.initials: L
authors.lastname: Dub
authors.affiliation: 4 Department of Pharmaceutical Services, William Beaumont Hospital , Royal Oak, Michigan.
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Holzhausen
authors.affiliation: 5 Department of Emergency Medicine, William Beaumont Hospital , Royal Oak, Michigan.
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Sawyer
mesh_terms: D000208:Acute Disease; D000368:Aged; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D017131:Thrombectomy; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D000925:Anticoagulants