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Pulmonary Infarction Follow-up

  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Michael R Bye, MD  more...
 
Updated: Jan 16, 2015
 

Further Outpatient Care

Monitoring prothrombin time (PT)

PT should be measured on a regular basis; the goal is an INR of 2-3.

Diagnostic workup

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.

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Deterrence/Prevention

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.[23] 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.

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Patient Education

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:

  • Pregnancy
  • Oral contraceptive pill use
  • Termination of pregnancy
  • Smoking

For patient education resources, see Lung Disease & Respiratory Health Center, as well as Pulmonary Embolism and Sickle Cell Disease.

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Contributor Information and Disclosures
Author

Lennox H Huang, MD, FAAP Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, Canadian Medical Association, Ontario Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

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