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Article Discusses The Importance Of DVT Prevention

There were two articles regarding deep venous thrombosis prevention in the November 2011 issue of the Plastic and Reconstructive Surgery Journal.  Both are worth reading.  I have supplied the full references below with links.

From the second article:

Between 1 and 7 percent of surgeons have personally experienced a venous thromboembolism–related patient death after high-risk plastic surgery.  Plastic surgeons’ self-reported practice patterns indicate a disparity between clinical understanding and clinical practice. The majority of surgeons can identify patients at high risk for postoperative venous thromboembolism. However, examination of their self-reported practice patterns indicates that a substantial proportion of surgeons (>50 percent) provide inadequate levels of venous thromboembolism prophylaxis for high-risk patients.  In addition, surgeons recognize modifiable venous thromboembolism risk factors (such as oral contraceptive use) but may fail to modify those factors before surgery.

“Never event” is a poor descriptor for venous thromboembolism, as it implies that Read more »

*This blog post was originally published at Suture for a Living*

FDA Requires Label Changes For The Patch

After cautiously clearing Yaz for continued use Thursday, an FDA Advisory Panel Friday addressed post-marketing data showing similarly increased blood clot risks among users of the contraceptive patch.  The committee, after having been clearly quite  extensively briefed,  heard testimony from Ortho Evra’s  manufacturer and experts in epidemiology, gynecology and hematology. They also heard moving testimony about  a young woman who died from a massive pulmonary embolism while using the Nuvaring, whose parents argued that not only the Patch, but most of the newer methods carry an increased clot risk that no woman should be allowed to take without being adequately informed.

The committee ruled that despite limitations of the data, the patch most likely carried a 1.5 times relative risk of blood clots compared to 2nd generation levonogestrel pills, but not necessarily higher than that of newer pills containing 3rd and 4th generation progestins and drosperinone.  With a few dissenters, the committee voted to allow the Patch to stay on the market, but asked for Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

True Story: Man Dies From Following Alternative Medical Advice On The Internet

Photo Credit: Mark Crislip, M.D.

During a recent trip, I met a woman whose father had just passed away. When she discovered that I was a physician, she decided to tell me the sad story of the events leading up to his death. She gave me permission to share the story on my blog so long as I did not identify her or her family by name. For the purposes of the story, I’ll refer to the woman as Sue, and her father as Frank.

Frank was a healthy, robust man, descended from a long line of nonagenerians. Everyone assumed that he would live well into his 90′s – at least 30 more good years. One day Frank began having some leg pain, which he ignored as long as he could. Sue noticed him limping around a week later and decided to take him to see a physician. As it turned out, Frank had a deep venous thrombosis (or blood clot) in his leg, caused by a previously undiagnosed, mild genetic clotting disorder. The physicians treated him with heparin to prevent the clot from expanding, and prescribed coumadin to protect him from having the clot travel to his lungs – a condition (pulmonary embolism) that carries with it a high risk of death.

While researching his new medicines, Frank came upon an alternative medicine website. The site warned people against taking coumadin (stating that it was “a form of rat poison”) and offering herbal supplements instead. Frank decided to stop taking his coumadin, and purchased the alternative medicine from the website. Two weeks later he Read more »

Should New Mothers Leave The Hospital With Birth Control?

image from www.blisstree.com

It depends on the method and whether the mother plans to breast feed.  Ideally, it is recommended that women abstain from sexual relations for at least 4 to 6 weeks after having a baby to reduce the risk of developing vaginal infections and of course, becoming pregnant.

Pregnant women have an increased risk of developing blood clots because of hormonal changes.  This is commonly referred to as a hypercoagulable state.  Birth control pills that contain both estrogen and progestin (aka combination pills) are not recommended for the first 42 days after the delivery because they increase the risk of blood clots in the legs (Deep Venous Thrombosis, aka DVT) and also decrease breast milk production. The vaginal ring and patch are also not recommended. However, birth control pills that only contain progestin are safe to take immediately after delivery because they don’t increase the risk of developing blood clots nor do they reduce the amount of breast milk production. The Depo- Provera injection may also be given as well because it is a progestin-only product. What women are at increased risk for developing a DVT? Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

The Perspective Of The Clinical Trial That You Need To Know

There are big companies like Quintiles that run clinical trials around the world. There are local clinics that specialize in clinical trials and make a lot of money at it. There are, of course, pharmaceutical companies and device manufacturers who depend upon the results to gain marketing approval for new products. People in all those groups know a lot about trials.

But the perspective that counts is the view from you and me – patients. Most of us do not enroll in clinical trials. We don’t want to get too up close and personal with anything “experimental.” And often our doctors never tell us about available trials anyway since it can be a lot of paperwork for them. Given that most people don’t enroll in trials and new science is delayed because of it and also because most people in trials are not journalists, I thought I’d put hunt and peck to the computer keyboard and speak out about trials. I am especially motivated because I have participated twice. The first one, a leukemia trial in 2000, I believe, saved my life. And I enrolled in a second one, studying a new drug for clots in the legs (deep vein thrombosis or DVT) just a week and a half ago.

I enrolled in the DVT trial because 1) the first one worked for me and 2) I crow all the time about how patients should always consider being in a trial as a treatment option. I had to put up or shut up. So I signed on the dotted line.

This particular trial, Read more »

*This blog post was originally published at Andrew's Blog*

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