Moving back out of ICU - but a quick question on clots

[Simon Booker]

Thank you all for you posts. The nature of Dad's bleed did mean that he required additional surgery, although they were able to manage this without opening all of his incision again - just the lower half. He was off the ventilator very quickly this time although felt a bit down yesterday which is understandable following another surgery.

He does have one issue that I'd welcome your views on - he has (they think but can't be sure) a clot in his left heart chamber and I'm not sure they have decided on the course of action yet. He's being started today on Wharafin (but low dose given recent Tempenad bleed that they could find no obvious source for in the surgery). INR target is 2-3.

Is the course of acion simply to leave these clots there, or do anti-coagulants actually disperse clots (I've had two opposing views from his Doctors). Current course of action is to monitor his condition. I'll push for an ultrasound this morning and get a cardiologist on the case if I don't sense a strategy. I also don't know how serious this is. I've been told that his clot cannot be that big (or it would have been removed in surgery) and that it should not move. Is simply administering an anti-coagulant in these circumstances the norm?

Thanks

Simon

 

[Ross]

Simon I'm not sure how they'd handle it. They could give him TPA, which is a clot busting drug, but that might not be a good idea. I'm thinking they're thinking to try to slowly dissolve it with Warfarin, but it will be interesting to see what they finally do.

 

[escargome]

Simon,
I can't weigh in on the doctors plan for the clot your dad has, but one thing I can do and will continue to do is pray. Please give your mum and the rest of the family a hug from me. I know this must be the most awful, confusing time of your lives. My mom had CHF for many many years and there were times when I didn't know if I wanted to just jump out the window or stay where I was when she would be hosptialized. So remember that your dad's guardian angel is there with him and God will help you all over this bumpy road.

 

[Simon Booker]

Thanks all

Thanks all

Thanks for your advice. It seems that there is no perfect solution to this, but the most sensible approach seems to be to medicate with Wharfarin for six weeks (INR 2-3) to prevent the clot from becoming bigger, but also to gradually break it down over time. I'm told that the position in the heart is OK - so the risk of movement during this time is very low. Alternatives are surgery to remove the clot (no thanks - two OHS's in the past 2 weeks are enough and I think in the circumstances, would pose a risk) or TPA as Ross suggested, but TPA is a risky solution as we are told 1 in ten people can suffer a life threatening haemorage. So we're going with the slowly-slowly approach!

Kind regards

Simon

 

[LOVE MY DAD]

hi simon good to hear they are able to treat with med i am still praying for your dad my dad just went back for surgery hope your dad gets to go home soon and gets the clots under control keep us updated

 

[skeptic49]

Sorry to read about the need for a second surgery for your Dad. I hope the clot issue can be resolved and that his recovery is smooth from this point forward.

Jim

 

[Ross]

Thanks for your advice. It seems that there is no perfect solution to this, but the most sensible approach seems to be to medicate with Wharfarin for six weeks (INR 2-3) to prevent the clot from becoming bigger, but also to gradually break it down over time. I'm told that the position in the heart is OK - so the risk of movement during this time is very low. Alternatives are surgery to remove the clot (no thanks - two OHS's in the past 2 weeks are enough and I think in the circumstances, would pose a risk) or TPA as Ross suggested, but TPA is a risky solution as we are told 1 in ten people can suffer a life threatening haemorage. So we're going with the slowly-slowly approach!

Kind regards

Simon

If they used TPA, I'd be more afraid of the clot moving out of the heart and into the brain before it dissolved. The drug can be a life saver or a death maker.