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Re: PMB on coumadinFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Fri Apr 27 16:57:08 2007
At Fri, 27 Apr 2007, Henry Gregor wrote: > >Listers > >A 53 yo, LMP 4 years ago, presents with two weeks plus heavy vaginal bleeding, w/o presyncopal sx's. She is on coumadin secondary to hx of mitral valve replacement. INR is 2.3, and pt is w/o petechiae, ecchymoses, or hx of epistaxis or bleeding gums, etc. > > PE is unremarkable, and a pap (neg hx abnl past ones) is pending. Sono with heterogenous endometrial stripe, at 7 mm. I am planning to do an endometrial pipelle sampling. Comments appreciated. > > Thanks > > Hank > >--------------------------------- >Ahhh...imagining that irresistible "new car" smell? >--------------------------------- >--------------------------------- >--------------------------------- > Check outnew cars at Yahoo! Autos. > >-- >--------------------------------- > >---------------------------------
>--------------------------------- INR of 2.3 sounds a litlle high, agree with sampling,hopefully strip thickness is mostly bloody tissue, if sampling is negative for hyperplasia with aytpia she wood be a good candidate for mirena. I have about a half dozen patients like this who are on coumadin for multiple conditions like anti-phospholipid syndrome with previous pulmonary emboli, and artificial heart valves; continious provera, depo-provera and mirena all work pretty good. They may still have some bleeding but usually not enough to drop thier hemoglobin. Obviously endometrial abalative technique of your choice is also an option.
--
Take care, John
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