Yes to cooling, no for mixed heparin.
Simon Odum
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Black, John
Sent: 07 September 2004 16:39
To: [log in to unmask]
Subject: Re: diagnosis and Rx of pulmonary embolism
Ayan,
I have had experience of thromobolysis in young PEA patients with
confirmed
pulmonary embolism on echo or confirmed DVT. Although the patients were
quickly resuscitated (5-10 mins of ALS) the neurological outcome was
poor as
a consequence of a completely obstructed circulation at normothermia -
this
was before systemic cooling protocols as recently advocated by IlCOR
(Circulation 108:118-121).
How many of you are implementing cooling strategies in unconscious
patients
following out of hospital cardiac arrest? Are you being selective?
Are any of you using unfractionated heparin in combination with Clexane
in
intermediate and high probability pulmonary embolism in the ED?
John Black
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Ayan Sen
Sent: 07 September 2004 14:25
To: [log in to unmask]
Subject: Re: diagnosis and Rx of pulmonary embolism
Yes,most investigations of hypercoagulability should be done when
patients
are off anti-coagulants as heparin interferes with assay for
antithrombin
III and lupus anticoagulant and warfarin affects protein C and protein
S.In
an acute stage,protein C,S and antithrombin III may be transiently
depressed
as well,therefore,it may not be worthwhile doing assays for
these.However,as
some haematologists say,that if there is lupus anticoagulant,which is
associated with recurrence,it may need a higher INR for therapy.But
there is
no consensus that all patients with DVT/PE should have a
hypercoagulability
work-up.The most common defects are not associated with recurrent
disease,
and the ones that are, are uncommon.
Incidentally,how many of you would thrombolyse/have thrombolysed a
cardiac
arrest patient with pulseless electric activity?
Ayan
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