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nbme3blk 4

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13 Posts

Guptashutosh
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01/14/07 - 09:27 AM

13. A 70-year-old woman is hospitalized for evaluation of a single, transient episode of right-sided weakness. She has type 2 diabetes mellitus controlled with diet. Seven years ago, she underwent lumpectomy and radiation therapy for localized breast cancer and has had no evidence of recurrence. Examination shows a left carotid bruit. Arteriography shows 80%–90% stenosis of the left internal carotid artery in a segment just distal to where it branches from the common carotid artery. On admission, her serum glucose level is 310 mg/dL; after adequate hydration, her serum glucose level decreases to 180 mg/dL. Serum electrolyte levels are within normal limits. Which of the following is the most appropriate recommendation to prevent cerebral infarction in this patient?

A ) Daily aspirin therapy only

B ) Insulin therapy only

C ) Low-dose heparin therapy only

D ) Warfarin therapy only

E ) Endarterectomy and daily aspirin therapy

F ) Endarterectomy and low-dose heparin therapy

G ) Endarterectomy and warfarin therapy

prathapdoctor
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01/14/07 - 09:28 AM

Endarterectomy and daily aspirin therapy.

sarika
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01/14/07 - 09:30 AM

i chose the same

nida
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01/14/07 - 11:32 AM

agree, E) Endarterectomy and daily aspirin therapy

dr.wad
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01/14/07 - 04:05 PM

yes ,endarterectomy and daily aspirin

fox
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02/22/07 - 02:15 PM

why not endarterectomy & low dose heparin?

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mjl1717
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02/22/07 - 02:26 PM

fox wrote:
why not endarterectomy & low dose heparin?

For the most part heparin is usually given IV in the hospital.

instead of copying: I agree , Iagree, I agree.

*greater then 70% occlusion --endarectomy and simple ASA as Aashi would agree increases mortality!!!!!!
raised eyebrow

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Aashi
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02/22/07 - 06:06 PM

Wht i know abt anticoagulation in terms of carotid endarterectomy is--->LOW dose heparin is give INTRAoperatively-->HIGH dose heparin is the one which is associated with bleeding, and which mite require protamine..
and ASA or clopidegrol is give preop and postop after endarterectomy..coz post op u just want to prevent rethrombosis,and heparin itself is not required coz u have already removed the plaque..
and i think warfarin use in noncardiac embolization is still controversial..

any other opinion is welcome

GL wink

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mjl1717
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02/22/07 - 06:51 PM

yes buddy!!

Do you mean Low molecular weight Heparin or Low dose Heparin?..

I was also thinking that clopidogrel (Plavix ) would be used in aspirin allergy..

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Aashi
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02/22/07 - 07:18 PM

#10

Low dose UFH, dint read abt LMWH for endarterectomy..intraop bleed coz of heparin can happen with doses >100U/kg

GL

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NE
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02/26/07 - 10:12 AM

#11

From AHA guidelines:
Patients who are undergoing endarterectomy should receive aspirin therapy beginning before surgery unless there are contraindications (Grade B recommendation). The optimal dose of aspirin is uncertain.
The heparin dose in the time of intervention should be weight-related- 85 ui/kgc to decrease postop. complications.

liwei
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Topics: 7
Posts: 72

02/28/07 - 11:02 AM

#12

E
Just my personal opinion. Tell me if you think I am wrong

heparin and warfarin used for AF or thrombosis of vein
aspirin for arterial thrombosis : nod

dr in trouble
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03/08/07 - 10:18 PM

#13

yes itz E .

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