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Mon Jan 15 00:31:14 GMT 2007

To the wise and informed trauma surgeons, nurses, and others on this List  
Server.     I posted similar letters to ccmL  and  Surginet in an attempt to 
determine if anyone else besides me has not learned of  a new alledged  "Standard 
of  Practice"?          It seems to me  that this is shot gun therapy and is 
DANGEROUS.     How can  such an urban legend get started??

HELP.    I try to remain well informed, but today I  encountered something I 
have not read in journals or text books, and have not  heard at any national 
meeting.    I was so dumbfounded from what  was told to me by a "senior" 
surgeon and interventional cardiologist, that I  just said, "really, can you tell me 
more or give me the source of the  "standard."

Here it is........

Today I was informed that in TWO major hospitals in Houston (NOT THE BEN  
TAUB General Hospital),  that it is a "Standard of Practice" to put all  patients 
in whom an IVC filter has been inserted on LIVELONG  Coumadin.   The same 
senior surgeon also indicated that Aspirin and  Plavix (LIFELONG) are also added 
in high risk patients.    I  discovered that it is not unusual to also receive 
Fragmin or Lovenox in these  same hospitals for patients with IVC filters.    

This "practice" seems totally illogical to me.    

HELP

1.    I have always thought that one indication for an  IVC filter was to use 
them in patients with contraindications to  anticoagulation

2.    What effect (if any) has Plavix had in preventing  or treating DVT in 
any location

3.    I cannot find the aforementioned "standard" in  the package insert or 
PDR of any of these drugs (ASA,  Coumadin, Fragmin,  Lovenox), NOR any of the 
IVC filters

4.    I was told that this logic is supported by  vascular surgeons, 
cardiologists, and intensivists, on the same logic as using  Plavix and Coumadin in 
patients with coronary stents (including drug eluding  stents.  --Weird

5.    Is there really really support for life long  Coumadin ASA Fragmin, or 
Lovenox in patients with coronary stents.

6.    What are the complications of this combined Rx  (IVC filter and drugs) 
across the board, and not just in selected  patients.    

I live in this city.   I abide by evidence based medicine, but am  subject to 
a local standard of practice.   Perhaps I just  misunderstood one of the 
senior surgeons, who is relative recent addition to the  TMC.   Perhaps this is 
just a shot gun therapy which was passed around  in the coffee room.    I 
checked with a nurse I know that  Coumadin (LIfe LONG) is commonly ordered by these 
senior physicians in patients  in whom an IVC filter has been inserted.    

Please either educate me or support my more traditional views on this  
subject. 

Kenneth L Mattox, MD
Houston

List Archives

For your convenience, find the Trauma List Archive Below

IVC Filters, Coumadin, Plavix,ASA, Fragmin