Are all doctors from 1907?

[Ross]

This could explain why there seems to be little understanding of Coumadin. In 1907:

Ninety percent of all doctors had NO COLLEGE EDUCATION!
Instead, they attended so-called medical schools, many of which
Were condemned in the press AND the government as "substandard."

 

[Marty]

Radiologists know ACT

Radiologists know ACT

Very true in 1907 but not true in 2007. Med school applicants almost always have four years of college with a bachelors degree and many have masters and PhD's. In my department the young radiologists do a lot of ultrasound guided biopsies, stereotactic biopsies, and CT biopsies. They always talk to patients about warfarin, aspirin, etc. They routinely bridge and never hold. We have easy access to an ACT clinic run by PhD pharmacists who have a large excellent technical staff. Im impressed. I was chatting with one of the interventional radiologists last week after listening to him counsel a patient before breast biopsy. I told him about the Mead case. He said very unfortunate, but even with bridging patients can be unprotected 24 to 48 hours. Pretty good for a radiologist, don't you think?

 

[bvdr]

Very true in 1907 but not true in 2007. Med school applicants almost always have four years of college with a bachelors degree and many have masters and PhD's. In my department the young radiologists do a lot of ultrasound guided biopsies, stereotactic biopsies, and CT biopsies. They always talk to patients about warfarin, aspirin, etc. They routinely bridge and never hold. We have easy access to an ACT clinic run by PhD pharmacists who have a large excellent technical staff. Im impressed. I was chatting with one of the interventional radiologists last week after listening to him counsel a patient before breast biopsy. I told him about the Mead case. He said very unfortunate, but even with bridging patients can be unprotected 24 to 48 hours. Pretty good for a radiologist, don't you think?

Marty, what do they do with ACT with mylegrams, spinal biopsies, and spinal surgeries? How often do they encounter bleeding problems in these patients? I know during the proedures ACT would not be taken into account unless it was an emergency situation since otherwise patients would be off ACT beforehand. I'm talking about incidences of post procedure bleeding in general.

 

[RCB]

I think

I think

Very true in 1907 but not true in 2007. Med school applicants almost always have four years of college with a bachelors degree and many have masters and PhD's. In my department the young radiologists do a lot of ultrasound guided biopsies, stereotactic biopsies, and CT biopsies. They always talk to patients about warfarin, aspirin, etc. They routinely bridge and never hold. We have easy access to an ACT clinic run by PhD pharmacists who have a large excellent technical staff. Im impressed. I was chatting with one of the interventional radiologists last week after listening to him counsel a patient before breast biopsy. I told him about the Mead case. He said very unfortunate, but even with bridging patients can be unprotected 24 to 48 hours. Pretty good for a radiologist, don't you think?

You are a treasure!

 

[Marty]

Marty, what do they do with ACT with mylegrams, spinal biopsies, and spinal surgeries? How often do they encounter bleeding problems in these patients? I know during the proedures ACT would not be taken into account unless it was an emergency situation since otherwise patients would be off ACT beforehand. I'm talking about incidences of post procedure bleeding in general.

Betty,I don't think we hold or bridge for myelograms. I have not done one in many years but do not remember any bleeding problems.. Currently it would be up to the neuroradiologist to decide. As for emergency surgery you would need a neurosurgeon to decide. Theirs is a delicate bloody business. I wonder if IV vitamin K would be used for an accident victim on ACT requiring surgery?

 

[MAR]

Betty, I know in my department the neuroradiologist will not perform lumbar punctures myelograms or spine biopsy on anticoagulant patients. There fear is that if you get even a small amount of bleeding in the spinal canal it can cause compression of the spinal cord and possible paralyis. It is not the fear of someone bleeding to death that stops them from doing it. Hope this helps

Mechanical Aortic valve December 2006

 

[bvdr]

Marty & MAR, thanks for your comments. I think that because there is so much contradiction in the medical community on what protocol should be followed regarding holding vs. not holding warfarin for procedures that it is like the little boy who cried wolf and when the wolf was really there no one believed him.

Ross, it used to be the same in many professions. My husband's grandfather was a teacher and principal of a school for years and years until sometime in the 1930s he was kicked out since college education became a requirement. At that time there was no such thing as someone being "grandfathered in".
My youngest son has his degree in criminal justice and was on a police force for about a dozen years. There was a wide variety of backgrounds....the only commonality was they were all required to go through a BTLS (basic training)course.

It was such a different world even when the first patients started taking warfarin. Not only were the patients pioneers but the doctors were as well. I think there will be some reasonable uniformity with warfarin management just about the time a replacement comes out for it.