I agree with Andy, especially if your figures are anywhere near correct.
What you're saying is that if he stops his warfarin, then he'll have a
one-in-a-hundred chance of an embolism over the next year. I would've
thought that compares favourably with the risk of his contusion converting
to a haematoma over the next few hours - you know he's got open vessels in
his temporal lobe! I wouldn't wait until the next day either, that'll be too
late. And finally I wouldn't burden the patient with the choice, especially
where I feel there is a clear winner and both negative outcomes are similar
anyway (strokes of one sort or t'other) and it's a little unfair on the
unfortunate patient with his contused temporal lobe, isn't it?
So my view would be to involve neurosurgeons, and possible cardiovascular
bods, but to reverse his warfarin pretty promptly!
Adrian Fogarty
----- Original Message -----
From: "Andrew Webster" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, October 12, 2002 12:34 PM
Subject: Re: Anticagulation and Head injuries
> I think I would, as the risk of thromboembolism with a prosthetic aortic
> valve is around 1 in 100 treated patient years. Reverse, wait ?who knows
> 2 weeks. Of course you need to provide informed consent to
> patient....weigh up risk/benefit ratio.
>
> Andy Webster
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of John Ryan
> Sent: 12 October 2002 12:16
> To: [log in to unmask]
> Subject: Anticagulation and Head injuries
>
> I am aware the list has discussed this topic recently but I would like
> to
> add a new slant.
>
> Views on how to manage a young man with a head injury and headache
> following
> a fall from his bicycle.... CT shows temporal contusion. This chap is
> on
> warfairn follwing his aortic valve replacement on a background of
> Marfan's
> Syndrome.
>
> The question is to reverse anticoagulation (INR 3.5) or not ?
>
> Dr John Ryan
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