Pulmonary Infarction Follow-up
- Author: Lennox H Huang, MD, FAAP; Chief Editor: Michael R Bye, MD more...
Further Outpatient Care
Monitoring prothrombin time (PT)
PT should be measured on a regular basis; the goal is an INR of 2-3.
A hypercoagulation workup should be performed if no obvious cause for embolic disease is apparent. This may include screening for conditions such as antithrombin III deficiency, protein C or protein S deficiency, lupus anticoagulant, homocystinuria, occult neoplasm, and connective tissue disorders.
Length of treatment
The length of treatment depends on the presence of risk factors. If no underlying risk factors are present, therapy can be stopped within 1-2 months. If risk factors are present, especially anticardiolipin antibodies, therapy should continue for at least 4-6 months.
Anticipate patients at risk. Any child with a risk factor may develop a pulmonary embolism (PE). See Causes. Methods to reduce risk include early mobilization, thromboembolic stockings, and prophylactic use of subcutaneous LMWH.
Current standard of care does not call for thromboprophylaxis in critically ill children without DVTs. Practice with adolescent patients is mixed with a large minority routinely prophylaxing critically ill adolescents.
Females of childbearing age should be advised regarding the increased risk of thromboembolic disease during pregnancy. Women who are sexually active should be offered appropriate contraceptive advice. Those who wish to become pregnant should be referred to an obstetrician skilled in the management of hypercoagulable disorders during pregnancy.
The importance of adherence to the treatment regimen should be repeatedly stressed. The patient should be instructed regarding what to do in the event of any bleeding complications. Because most patients are administered warfarin upon discharge from the hospital, they must be advised regarding potential interactions between warfarin and other medications.
Risk factors for the development of pulmonary embolism should be discussed, including the following:
Oral contraceptive pill use
Termination of pregnancy
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