I had mild feeling of deja vu reading this e-mail. I asked the list a couple
of months ago about this problem and did some reading around. I couldn't find
any clear evidence based consensus view on wafarin and thrombolysis. My feeling
is is that wafarin is not really a contra-indication to thrombolysis. Indeed,
if a patient can tolerate wafarin, they may be better placed to "survive" thrombolysis
since any occult bleeding diathesis would have been revealed prior to the infarct.
I certainly discourage SHOs checking an INR before they administer thrombloyis,
since this usually entails a one or two hour delay. I could not find any any
evidence that wafarin reduced the risk of ischaemic events. As a interesting
aside I found that Haemophiliacs have a lower rate of myocardial infarction
than the normal population.
Secondly, I agree with the sentiments being aired about the nature of the list.
I joined the list hoping for academic discussions about clinical emergency problems.
I now find that academic discussions make up less than 60% of the e-mails that
I receive. Is there an alternative for people who wish to air political, organisational,
social or operational opinions? Perhaps they could be redirected.
Adrian Boyle
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