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Sun Mar 15 16:05:17 GMT 2009

This is very interesting.   It borders, if not outright,  governmental 
practice of medicine.    These two drugs are NOT  therapeutically similar and for 
trauma, one of them has not been  validated.   One of these drugs has had 
problems with increased  bleeding, and inadequate clot formation prevention.   It is 
alleged  that some deaths have been attributed to the change to a 
"therapeutic  equivalent" drug without the physician users being in the loop.   

k

In a message dated 3/15/2009 10:55:28 A.M. Central Standard Time,  
nmcswai at tulane.edu writes:

What has  been the group experience with Deltiparin (Fragmin) as the 
prophylaxis.   As of April 1 our pharmacy will no longer supply enoxaparin (Lovenox). 
This is  directive from the state level not local. All of our public hospitals 
are run  be the state of Louisiana not the city or parish (county)  

Norman

Norman McSwain MD
Trauma Director, Charity  Hospital
Professor of Surgery, Tulane University
New Orleans LA
504  988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>  

________________________________

From:  trauma-list-bounces at trauma.org on behalf of moore677 at aol.com
Sent: Sun  3/15/2009 9:25 AM
To: trauma-list at trauma.org
Subject: Re:  DVT

No evidence to support IVCF if you can safely anticoagulate  the patient and 
they haven't already failed therapeutic anticoagulation.? If  clot is above 
knee popliteal, should fully anticoagulate.? If below knee,  would monitor with 
serial duplexes, although this is not widely agreed  upon.

According to the 2008 ACCP guidelines, fully anticoagulate  incidental 
proximal DVT (above  knee).

Dell....................

Forrest "Dell" Moore, MD,  FACS
Trauma Critical Care Surgery
Co-director Trauma & Surgical  ICU
St. Joseph's Hospital and Medical Center
eICU Intensivist/Critical  Care Medicine
Banner Healthcare System
Phoenix, AZ
Cell 480 284  1703

-----Original Message-----
From: nappio at aol.com
To:  Trauma &amp; Critical Care mailing list  <trauma-list at trauma.org>
Sent: Sun, 15 Mar 2009 5:46 am
Subject:  Re: DVT

Place a removable greenfield and anticoagulate. Can  help prevent propagation 
of
the clot and reduce his post phlebitic  syndrome(anectdotal).  Has he been 
tested
for deficiencies like anti  thrombin 3, factor5 leiden, S/C proteins, etc?
------Original  Message------
From: Errington Thompson
Sender:  trauma-list-bounces at trauma.org
To: 'Trauma & Critical Care mailing  list'
ReplyTo: Trauma & Critical Care mailing list
Sent: Mar 14,  2009 23:01
Subject: DVT

Trauma patient in the ICU on the vent.   The 48-year-old gentleman who was
involved in a motor vehicle crash.   The patient was found to have the
following injuries -- 4 rib fractures,  pulmonary contusion, T4/T5 chance
fracture without neurologic deficit and a  scapular fracture.  The patient is
on prophylactic doses of a low  molecular weight heparin.  An ultrasound
seven days after the injury  reveal a nonocclusive thrombus in the popliteal
vein.  

Treatment?

Errington C. Thompson, MD, FACS,  FCCM
Trauma/Critical Care
Talk Show Host - WPEK 880  AM
www.whereistheoutrage.net

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