AboutNigel Simmons Expertise I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised.
Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner.
I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question.
Consider.. would you want me to discuss your care with a friend or relative without your knowledge?
Experience Registered as a UK pharmacist in 1982 and have worked in a number of hospital and health management posts around the UK. Formerly Chief Pharmacist for a 440 bed general hospital in Cambridgeshire.
Past/Present clients Previously Sysop on CompuServe UK Professionals forum.
Question My sister recently had an unruptured brain aneurysm, which she was treated for using a coiling procedure. Approx 1 month later since leaving the hospital, she developed a blood clot on her lung and was hospitalized again. We were first told that she could not take cumadin because of the aneurysm she had had. Within a few days later after being released from the hospital for the blood clot, she began to have pain. She went to the ER and now they have put her on cumadin, saying it will help with the blood flow and keep the clots from returning. I am not comfortable with the indecisiveness of the doctors. Please help.
Answer J
I don't think the doctors are being indecisive, just juggling complex alternatives and associated risks in response to a changing case history.
Some surgeons would prescribe short term anticoagulants after stent insertion because of the risk of clots forming on the coil itself, but this may be considered inappropriate in some circumstances. However in reducing the risk of clot formation, there is an increased risk of bleeding causing a stroke or haemorrhage, so it's a difficult call and would depend on the size and location of the aneurysm, age and general health of patient etc.
As it turned out, your sister developed a clot on her lung, and so commencement of anticoagulants is definitely indicated. Once there is one clot, there is a high probability that the clot could grow, more could form and all will be unstable and highly likely to be dislodged into the general circulation.
I think under the circumstances, the ER doctors have made the correct decision.
