Hypoxia and Medicine

Can anyone advise me about best practice treatment options for a post operative pulmonary embolism?

My husband is 48. He is a healthy, normal weight range, very fit non smoker . He had an arthroscopy with some unexpected other repair work done to his femur and knee cap on 22nd Dec.It was done under general anaesthetic which lasted less than four hours. It was a day stay procedure. He was given no asprin, no compression stockings and had no follow up appointment scheduled until 15th January. There was no referral letter to his GP. He was given codeine 60 mg every 6 hours as a pain reliever. He began coughing blood at 9 am 29th Dec and had spent a night with severe pain in his left side...which he didn't tell me about at the time!! He is being treated with Clexane and Warfarin subcutaneously. His oxygen saturation is being monitored. He will be in hospital for a minimum of 3 days. Is this the best course of action?

Public Comments

1. http://www.sanofi-aventis.com.au/products/nzl_ds_clexane.pdf http://www.merck.com/mmpe/sec05/ch050/ch050a.html#sec05-ch050-ch050a-526 I am no doctor, so I just have questions that you might pose to the doctors and the above links to help suggest more questions. I expect that the Clexane is temporary therapy until the anticoagulant warfarin kicks in. The dosing of Celxane depends on how well the kidneys are performing, so one question I would have would be to consider that a clot to the blood supply to the kidneys might effect the elimination (and therefore the dosing) of Celxane. You did not mention specifically that he had oxygen therapy, from what little I know oxygen helps treat pulmonary hypertension, which sometimes develops with pulmonary embolism. So, if it were me, I would want some extra oxygen. You would want to read up on the clexane causing thrombocytopenia, something of an allergy that causes the blood platlets needed to stop bleeding to not work. That might not be a problem if the therapy is short. You would also want to review the drug interactions and drug/disease interactions of warfarin, like if he might have a history of stomach/intestine ulcers that could lead to bleeding in the gut. The question of using clot busters? From what little I have read they are more risky if the person is on drugs like clexane/warfarin. That is tricky business for even doctors to decide from what I have read. This is all of the little I know.
2. Yes, I agree it is the standard treatment. If he was hemodynamically unstable then fibrinolytic therapy (clot busters) would've been almost essential provided there were no specific contraindications. However this decision is made by the emergency dept physician at the time of admission in ER and I cannot judge from here. (Since he was not offered fibrinolytic therapy I assume he was stable) Clexane will probably be given for a week but will continue with warfarin. Warfarin therapy will be required for a considerable time to prevent progression and recurrence of the embolism. This anticoagulation is very important. The duration best decided by his physician. He would probably already be wearing the compression stockings now. Supporting treatments include oxygen and fluids which he is receiving. Overall I think he should be ok.