This is a short medical case presentation with an important teaching point.
Would you please correct it for me to be fluent.
To all my dear colleagues,
A couple of days ago, in our morning report, post-call residents presented a 26 year old unmarried lady, with acute non-massive pulmonary embolism, based on typical symptoms and diagnostic pulmonary CT angiography. Her VTE was provoked following OCP. Treatment had been started with Clexan and Coumadin, decided to continue for six months.
All seems easy and straight forward as yet, but imagine that she will come back to you 5 years later, married and decides to become pregnant, and asks you if anything is advisable for her according to her this past history? Does she need VTE prophylaxis in pregnancy period, post-partum period, both or neither? What do you recommend?
The answer for this lady, with past history of provoked VTE following PCP, is YES for both periods. According to ACCP guideline 2012, She needs VTE prophylaxis during both pregnancy period and also 6 weeks post-partum with Clexan 40 mg SC daily or Coumadin with target INR 2to 3.
Below you can see the pertinent recommendations from ACCP.