PIG Meeting: 13th May 2021

Female patient in her 30s. Ex-athlete with severe hip OA.

Background

• PE post-partum, approximately 3/12 ago
• Obesity BMI 42, previous sleeve gastrectomy

Issues:

• Recent PE
  • Likely precipitated by non-adherence to enoxaparin post-partum (prescribed due to VTE risk)
  • Severe SOB symptoms at the time, now resolved

Discussion

• ? Appropriateness of surgery timeframe
  • Initially the surgeon/haematologist all on board with plan for surgery 3/12 after PEs
  • Later appeared that perhaps that patient had put significant pressure on clinicians to create these plans
  • Awaiting further respiratory r/v
  • BMJ Best Practice: Anticoags can usually be stopped after 3 months (or 3 to 6 months for people with active cancer) if the PE was provoked, as long as the transient risk factor is no longer present and the clinical course has been uncomplicated. Anticoagulation is usually continued for longer if the PE was unprovoked.
  • The clinician involved in this case uses presence of residual clots on V/Q scanning to guide anticoags.
  • Usually semi-urgent surgery undertaken after 3/12 delay after PE/DVTs, however elective surgery often delayed further to reduce risk as much as possible. Limited evidence to guide a complex clinical situation.

Plan:

• Surgeon now keen to postpone surgery further. Group consensus is that this is safer for the patient.
• PIG doctor will update the respiratory physician on progress to ensure all clinicians are informed of the complex events thus far.