72-year-old man for gastroscopy and colonoscopy
- Surveillance colonoscopy for previous benign polyps
- Gastroscopy for chronic GORD symptoms
- BMI 57
- NIDDM, good control
- PAF, on Apixaban
- Pulmonary Hypertension, routine echo in 2017
- Recent Bilateral PE’s (April 2021) with significant clot burden
- Admission with sepsis and AKI 2 months previously and DOAC ceased
- No investigations for OSA; STOPBANG 8 and Epworth Sleepiness Score 12
- Not known to respiratory physician and no follow-up in place from hospital admission
Should procedure be postponed?
- Yes. Elective procedure. No red flags.
- Surgical team in agreement.
- Postpone until 6 months post PE.
- Postponement of 3 months is usually adequate. A longer timeframe was selected in this patient due to the severity of his disease and complex comorbidities.
- Referral to respiratory physician; significant clot burden, should he have repeat imaging before interruption of anticoagulation?
- Clinical suspicion of OSA (and possibly OHS) given multiple risk factors, ESS, and long-standing pulmonary hypertension.
- Plan to discuss with respiratory physician
- Postpone for at least 3 months
- Repeat echocardiogram
- Referral to respiratory team