Anti-coagulation question

[macdaddy23]

Just something that I've run across and wonder how others treat---seen it done different ways.

If you have a person for whatever reason on Coumadin who you diagnose with a new DVT or even a subclincial PE, if there INR is therapeutic can you just discharge them?
What if they are on Coumadin and just slightly sub-therapeutic can you just increase there Coumadin and get it re-checked by there primary later in the week?

Any thoughts??

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[southerndoc]

Depends. Were they on warfarin for a while? Is this a new DVT?

If a person has been on warfarin for only 2 weeks and comes in and gets diagnosed with a DVT in the same extremity, then I'm unlikely to do anything.

If the person has been on warfarin for 6 months and has another DVT in the same extremity, or is on warfarin for a few weeks and has a DVT in a new extremity, then these patients are candidates for heparinization and probable IVC filter placement.

Patients that still develop clots while on warfarin are at significant risk for fatal PE's and should have a filter placed.

 

[waterski232002]

If they have a prosthetic valve, it is essential that their INR is therapeutic ASAP. Whatever the reason, I like lovenox if their Cr is okay... they can go home with a weeks supply until follow up w/ their PMD.

 

[drsutter]

If they are on coumadin (therapetuic level) and still develop new DVT, that means it's not working and need another intervention, i.e. filter. If they already have the filter and on coumadin and still develop DVT, well, start praying.