In-Reply-To: <[log in to unmask]>
>
> I was recently confronted by a patient with an extensive anterior MI
> who was
> on wafarin for af. His INR was 2 and I thrombolysed him. I was
> criticised by
> the (junior) medical team. Their complaint was that the combination of
> wafarin
> and TPA was dangerous and particulary prone to a bleeding complication.
I think that in today's climate of Clinical Governance we all need to
ensure that we are practising evidence-based medicine. Conversely, before
we open our traps to criticise someone else, we should have a firm basis
for that criticism.
What is available as evidence?
I have searched medline for about an hour to find a paper looking at the
effect of thrombolysis on a patient with disordered clotting - in vain. In
particular, I have looked for papers on thrombolysis with streptokinase in
a patient already receiving warfarin. I can find nothing at all. There is
therefore no readily available evidence either way, and your approach can
be considered successful as the patient survived. I suggest you ask your
colleagues what evidence they base their complaint on.
Can anyone else help, or should this patient be written up as a case
report to be followed by a proper trial?
Best wishes,
Rowley Cottingham
[log in to unmask]
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|