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Old 09-07-2011, 07:30 AM
Location: Bucks, UK
523 posts, read 3,512,406 times
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so if he was admitted for 4 days prior to this trip with a PE, then it appears it wasnt a life threatening PE - this much is good. he is now presumably on warfarin (or equivalent), and it is critical that he continues to take this, and to closely follow the directions which come with it. he should avoid alcohol (and a ton of other meds) which can make the warfarin either more or less potent than it should be, and avoid certain foods and alcohol - he should have been given this information when he started on this medication - but there should be a lot of info easily available online. also, he will need to have blood tests to check how well the warfarin is working, especially as someone who is new to this drug.

other than that, he should keep well hydrated, and try to avoid prolonged immobility - all of which can make things worse. when he gets back, if he hasnt already, he probably ought to be investigated further for any underlying cause of the PE - in an otherwise healthy, not overweight, non-smoker, there might be a reason to explain why he suddenly developed a PE.
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Old 09-09-2011, 06:27 AM
Location: Durham UK
2,031 posts, read 4,852,825 times
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Sounds like the Drs in the US may not have checked for Pulmonary emboli (PE) by doing a VQ scan.
They should also have scanned both his legs for blood clots as .frequently, PEs originate in the deep veins of the legs.
He should not have been discharged until he had commenced warfarin, and should have been having treatment dose heparin injections until the warfarin had been in his system long enough to thin his blood to the desired level, measured by something called the INR blood test.

Other scenario is that he did have pneumonia and developed thromboses in his legs as a complication of bedrest/dehydration and these weren't picked up on.If he was in hospital and on bedrest for his pneumonia then he should have been given preventative heparin injections.

He was discharged and then took a longhaul flight without any treatment in place, eg anticoagulants.

Hopefully Germany have looked at the veins in his legs for clots?

Warfarin won't dissolve the blood clots-it's not a thrombolytic agent like streptokinase or tPa.It will hopefully prevent the clots from getting any bigger and any new ones from forming.The body will break the clots down itself over time.

Once he gets back to the US he needs to get his blood check (INR) for his warfarin control and then preferably find someone who is a certified anticoagulation service provider to manage it from there on. Believe me, many Drs have no idea how to manage it and the tighter the control ie closer the INR result is to the target INR the better as this reduces the likelihood of more clots and also the risk of bleeding.
He should also carry a card saying he is on warfarin and tell his dentist and any other health care provider he sees.
There are new alternatives to warfarin on the market now.Less messy-ie don't interact with as many medications and are more predicatble in their action.
I think Dabigatran was licensed by the FDA last year and there may be another one that's about to be licensed.
I would enquire about it.
Also make sure he gets an appointment to see a hematologist as soon as he returns.

Last edited by Whatsthenews; 09-09-2011 at 06:48 AM..
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