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Re: What would you do? From: art fougner, md (evsono@pipeline.com) Thu Dec 28 09:06:27 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard Lisse: "Re: What would you do?" Previous message: DoctorJoe@aol.com: "Re: GEN: Deformer Babies" In reply to: DoctorJoe@aol.com: "Re: What would you do?" Next in thread: Dr Eberhard Lisse: "Re: What would you do?" Reply: Dr Eberhard Lisse: "Re: What would you do?" EL At some point, a consult with TJ for thrombophilia work-up may be helpful. For the immediate situation, anti-coag ->> schedule elective section --->> reverse anti-coag --->> section --->>> reinstitute anticoag just as JoeP posted. A useful reference ... N Engl J Med. 1997 May 22;336(21):1506-11. Management of anticoagulation before and after elective surgery Art At Thu, 28 Dec 2006, DoctorJoe@aol.com wrote: > >In a message dated 12/28/06 3:51:26 AM, el@lisse.NA writes: > >> I have inherited a patient of my colleague who is away over the holidays, >> >> Two previous Caesars, pulmonary embolus in February 2006, went off the >> pill, and duly fell pregnant at now 36 weeks, to get another pulmonary >> embolus yesterday. Is now in ICU but clinically well, not dyspnoeic at >> all, in the care of an Internist on Clexane. >> >> I have asked for an Ultrasound for dates (for all it is worth) and fetal >> wellbeing, and ordered serial CTGs. >> >> I forgot to mention that she is a colleague (Pediatrician). >> >"Routine" care on anticoagulants until such time as you normally schedule a >repeat Caesar. Then reverse the anticoagulant, do the deed, then thin her out >again. This time keep it going for a while. > >And then she needs probably a more thorough work-up for clotting problems, >since this is her second. Two PEs in one year, if they're not related to any >single inciting factor, are not "normal" for Paediatricians, I don't think. > >Joe P. > >P.S. Typical that she's a physician. Only thing worse would be if she were a >lawyer (or married to one). -- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: Dr Eberhard Lisse: "Re: What would you do?" Previous message: DoctorJoe@aol.com: "Re: GEN: Deformer Babies" In reply to: DoctorJoe@aol.com: "Re: What would you do?" Next in thread: Dr Eberhard Lisse: "Re: What would you do?" Reply: Dr Eberhard Lisse: "Re: What would you do?"

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