| Anticoagulation Management | Hemostasis & Thrombosis Clinic | Women
Inpatient Pharmacist H&T
Women's Hemostasis & Thrombosis Clinic
The Women’s Hemostasis and Thrombosis Clinic at Duke was formally organized in July of 2000 in response to the needs of women with bleeding and clotting disorders. Starting in 2002, the Centers for Disease Control and Prevention’s Division of Hereditary Blood Disorders recognized and began funding Duke’s Comprehensive Hemostasis and Thrombosis Center, in part because of the important work of the Women’s Clinic. The Women’s Clinic has a Gynecologic Program that serves the needs of women who have a bleeding disorder or are on anticoagulation and require management of menorrhagia. The Obstetric Program primarily serves the needs of women who have blood disorders and are pregnant or desire a pregnancy.
Since its inception in 2000, the Obstetric Program of the Women’s Hemostasis and Thrombosis Clinic has been supported by the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology and the Division of Hematology in the Department of Medicine. Both divisions recognize that women with clotting disorders are at an increased risk of thrombosis during pregnancy and an increased risk of poor pregnancy outcome. Many require anticoagulation during pregnancy. Anticoagulation in pregnancy requires vigilance and anticipation of the potential bleeding complications which may occur at the time of miscarriage or childbirth. Women with bleeding disorders are also at risk of bleeding complications. Pregnant women with bleeding and clotting disorders are best served by the combined expertise of a multidisciplinary team such has been assembled at Duke.
Current staff for the Obstetric Program is:
- Elizabeth Livingston, M.D. - maternal-fetal medicine specialist
- Leo Brancazio M.D.– maternal-fetal medicine specialist
- Kathy Vokaty RN, PA – physician assistant from the Division of Hematology
- Thomas Ortel M.D., Ph.D. – Medical Director of the Anticoagulation Clinic and back-up for the physician assistant
- Laura Brown RN, NP – nurse practitioner, Raleigh office
- Kristin Paulyson Nuñez M.S., C.G.C – genetic counselor
- Geraldine Wahlay – patient education and nursing support
Services are provided at weekly sessions held at the Duke Perinatal office at 2801 Erwin Road, Durham, NC, 27705.
- Preconception counseling
- Genetic counseling – not only routine, but also specific to the needs of women with inherited disorders of bleeding and clotting and women at-risk for an affected child.
- Obstetric ultrasound
- Prenatal diagnosis
- Antepartum testing
- Labor, delivery and postpartum management
- Collaboration and consultation with other specialties, particularly anesthesiology, neonatology, pediatric hematology, cardiology and pulmonary/critical care medicine