dvt anticoagulation ques

[corona 247]

Intern here on ICU month.

Lady came in with afib w/ rvr, pneumonia, and RLE pain/edema/erythema.

LE u/s came back unofficially (from tech) as +dvt.

Pt was therapeutic on admission with home coumadin (inr 3.0), and is s/p ivc filter in 2000.

Since pt is therapeutic, no further tx was intiated for the dvt.

Pt's daughter works for a local cardiology group and called to question why we were not treating with heparin to "treat the blood clot" . After explaining why we were not, she continued to say, that per her cardiologist, the use of therapeutic heparin has found to be helpful in treating acute dvts despite being already therapeutic on INR.

Am I missing something here? Is there any data to support her claim?

Thanks!

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[jdh71]

Hmmm, I browsed through the 2008 ACCP DVT guidelines last night and I couldn't find anything regarding clots on warfarin (but there's a lot and I could have missed it).

I'm going to have to keep looking, but I think once you clot on coumadin, you've bought yourself lovenox for life plus a cancer and hypercoag work-up.

EDIT: You sure this isn't old chronic clot?

 

[LukeWhite]

http://www.ccjm.org/content/76/12/724.full

 

[jdh71]

http://www.ccjm.org/content/76/12/724.full

This doesn't help one bit. She's not talking about warfarin resistance, which is >105mg/wk to get INR into therapeutic range, but rather a patient on coumadin with a therapeutic INR, who still had an acute clot.

Do you see the difference? Did you actually read the article?