My Dad has a blood clot smack in the middle of his pulmonary?!


Question:

My Dad has a blood clot smack in the middle of his pulmonary?

artery and he has had it for 12 days before being seen by a Doctor, he is extremely stubborn and refused to go to the ER, being that he weighs 350# the doctors dont want to do any surgeries or procedures thinking he end up with a stroke or other complications, so they are going to send him home with Coumadin and major pain meds d/t severe pain, does this mean he will be a ticking time bomb. the doctors say he cantt get any worse and the clot isnt going any where and in fact they said it is already in the worse spot that it could be in.. What is the prognosis of this and is he pretty much a ticking time bomb, Thanks for any input! the pain is d/t ischemia from the blood clot laying where it is.


Answers:

Actually, medical therapy with Coumadin is pretty much the standard of care when patients present with a pulmonary embolus; additional surgeries or procedures are usually not needed, whether your father is obese or not. Basically, if you can prevent the clot from progressing, the body's natural systems will usually dissolve it over time. There are occasional cases in which more powerful clot-dissolving medicines are given, usually if the patient's heart is having trouble pumping against the increased load caused by the clot. That's not without risk, though - typically a stroke risk of around 1%. There *is* a surgery to remove pulmonary emboli - but it's a very high risk surgery not performed in many places, and it would essentially never be considered without a trial of medical therapy first, unless the patient is dying in front of you.

The only additional procedure that *might* be considered is a filter placed in the IVC (large vein returning blood from the lower half of the body), especially if there's still visible clot in the legs or pelvic veins on ultrasound. That has risks, too, though - and clots can actually form on the *filter* after a while. Nobody really knows which is the right patient in whom to put in a filter, though. In most cases, in most places, the initial therapy would be with Coumadin alone, continued for 6-12 months, unless there's right heart failure or recurrent pulmonary embolism.

The prognosis is hard to quantify without more information - specifically, how sick he is, how well his heart is pumping, how big the clot is, whether he has other medical conditions, etc.




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