I am curious: how exactly does a set of rigorously reviewed, evidence-based guidelines from an international group of physician-experts sound cavalier?
Please clarify - based on data, not opinion - why this analysis was sufficently compelling and convincing to be published by this organziation but you think they "did not have a true appreciation." After all, we advocate evidence - not opinion - based practice, don't we? Marilyn Hanchett RN IgG America -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway Sent: Thursday, September 14, 2006 10:36 AM To: Kokotis, Kathy; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: Portacath warfarin prophylaxis I included this in one of my AVA presentations. Use of warfarin as prophylaxis is a controversial issue with studies being very small and showing both a positive outcome and no benefit. If it is used, even a low dose of 1-2 mg per day requires monitoring of PT and INR. This can be the problem as these coag times can be very high even with small doses. A set of practice guidelines on anticoagulants and thrombolytics published in Chest from the Thoracic surgeons in 2004 did not support the routine use of low dose warfarin. But, in my opinion, the did not have a true appreciation for the huge burden from catheter-related thrombosis. They had very little data and their statements almost sounded very cavalier about the issue. Lynn At 8:10 AM -0600 9/14/06, Kokotis, Kathy wrote: >I think the jury is still deciding on this one In fact at AVA one MD >agreed with the usage for those who had previous thrombosis and a high >risk of thrombosis for cancer patients and that was the Italian >Physician who was setting up country wide vascular access guidelines >from the EVAN project. > >Studies go both ways but a wise doctor said to be what does it hurt >with a low dose for someone who is high risk? > >Kathy > > > > > >Confidentiality Notice: This e-mail and any attachments are intended >only for the use of those to whom it is addressed and may contain >information that is confidential and prohibited from further disclosure >under law. If you have received this e-mail in error, its review, use, >retention and/or distribution is strictly prohibited. >If you are not the intended recipient, please contact the sender by >reply e-mail and destroy all copies of the original message and any >attachments.[v1.0] -----Original Message----- > >From: [EMAIL PROTECTED] >[mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] >Sent: Wednesday, September 13, 2006 10:48 AM >To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; >[EMAIL PROTECTED] >Subject: Re: Portacath warfarin prophylaxis > >See Cancer Control Journal of the Moffitt Cancer Center. Vol. 12, >September 2005., Supplement 1 "Venous Thromboembolism and >Cancer:Current Issues and Treatment Directions" >www.MoffittCancerCenter.org/ccjournal > >page 34 question #7. > >-----Original Message----- >From: [EMAIL PROTECTED] >To: [EMAIL PROTECTED]; [EMAIL PROTECTED] >Sent: Wed, 13 Sep 2006 9:30 AM >Subject: Re: FW: Portacath warfarin prophylaxis > > This is a controversial issue. There are small studies in >oncology patients that support its use and some that do not. There was >a series of practice guidelines related to anticoagulants and >thrombolytics published in Chest 2004 and they recommended against its >use. My opinion of that piece was that they did not have a good >understanding of the true clinical impact of catheter-related >thrombosis. But that is the most recent thing I can recommend. Lynn > > > At 8:24 AM -0700 9/13/06, Marilyn Patterson wrote: > This question from an internal medicine doc. Has this >recommendation changed? Does any one have any references I can forward >to this MD? > Thanks as always so much for all your valued input and expertise. >Marilyn Patterson RN CRN, CRNI Port Angeles, WA -------- > From: Mark Fischer > Sent: Tuesday, September 12, 2006 3:41 PM > To: Marilyn Patterson; Tami Spaeder > Subject: Portacath warfarin prophylaxis Hi Marilyn or Tami >Historically, pt's have taken warfarin 1mg/day for this.. Recently, >I think I've heard this is no longer recommended, right ? Do you >have a reference to support this ? Thanks mark > > > > -- >Lynn Hadaway, M.Ed., RNC, CRNI > Lynn Hadaway Associates, Inc. > 126 Main Street, PO Box 10 > Milner, GA 30257 > http://www.hadawayassociates.com > office 770-358-7861 > > >_______________________________________________________________________ >_ Check out the new AOL. Most comprehensive set of free safety and >security tools, free access to millions of high-quality videos from >across the web, free AOL Mail and more. -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861
