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Mon Jan 15 10:32:14 GMT 2007

Dear dr mattox,

As you have cross posted this on surginet as well as this list. we had discussed this tendency in august.The argument pro and con are summed up here.clearly things may have gone much further  in huston than the debate here in these articles, tom horan  <<anti coag + IVC filter.pdf>> 

> ----------
> From: 	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of KMATTOX at aol.com[SMTP:KMATTOX at aol.com]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	domingo, 14 de janeiro de 2007 22:31
> To: 	trauma-list at trauma.org
> Subject: 	IVC Filters, Coumadin, Plavix,ASA, Fragmin
> 
> 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
> 
> --
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