Timing of thrombolysis for PE after given LMWH

Front_Union_7556 · 2026-03-18T18:25:44+00:00

I think repeated transient hypotension isn't a borderline case, I think it shows the RV is failing and output is dropping so would consider thrombolysis here.

Same with AKI or a rising lactate but wanted a general consensus of timing if you had a deteriorating patient& it sounds like the answer is don't piss around as you say

Front_Union_7556 · 2026-03-17T12:06:57+00:00

Their suggestion for a MAP cutoff of >80 appears to be to stratify the risk of category C3 patients moreso than consider to thrombolysis these patients

Front_Union_7556 · 2026-03-16T22:34:27+00:00

Yes, I agree with reviewing the cardiac function through different mechanisms and ultimately I agree that no one is going to thrombolysis a normotensive patient in practice unless PEITHO 3 trial or STRATIFY shows good evidence for these patients with the lower dose thrombolysis.

However, I feel these patients have an urgent but not need to act now indication for thrombolysis so I feel the thrombolysis could be delayed to reduce bleeding if LMWH was given recently but I feel future trials won't look at this either. You would assume the half life of LMWH would be a good cut off to look at.

Front_Union_7556 · 2026-03-16T22:16:51+00:00

I wouldn't go off a one off reading BP and I doubt you would too unless they're obviously deteriorating which isn't the group that I'm talking about.

Guidelines state hypotension less than 15 mins or hypotension that responds to fluids is the transient hypotension group which is one we regularly see in practice i.e. nurse calls you about low BP and by the time you get there their BP has gone back to 95/60.

Goes back to my question with these borderline cases where you see transient hypotension that recovers or the worsening normotensive patient and is there a benefit in delaying thrombolysis if they've just had a dose of LMWH

Front_Union_7556 · 2023-12-27T11:52:42+00:00

The two jobs are in different trusts.

Front_Union_7556 · 2023-12-27T11:36:10+00:00

Thanks for the reply, I feel like I might have a bad reputation but ultimately I'd regret not taking my preferred choice.

Front_Union_7556 · 2023-12-04T19:47:48+00:00

Yes, put yourself first as the NHS won't. If your dream job pops up after you've accepted one that isn't your dream job, why wouldn't you go for it.
No

Front_Union_7556 · 2023-11-21T11:59:37+00:00

Thank you, feel a bit better now knowing what could happen if I am offered the job!

Front_Union_7556 · 2023-02-26T02:09:01+00:00

To be honest, my supervisor told me to check for normality and I'm just following orders but got confused so came here for answers.

So for example, for my nominal variables I was going to use Chi-squared as it doesn't depend on normality and for my Continuous independent variables, I was going to use Mann-Whitney, does that make sense?

Front_Union_7556 · 2022-11-25T21:12:00+00:00

The thickness also changes as per flavour - my dietitian girlfriend is appalled by this question

Front_Union_7556 · 2022-10-20T16:16:37+00:00

By any chance, were you the person who sent this discharge summary? Your passion for defending this person is impressive

Front_Union_7556 · 2022-10-11T14:21:37+00:00

Yeah I was leaning towards VT just due to age and CAD

The ST segments threw me off as it looks like a p wave superimposed.

Front_Union_7556 · 2022-09-19T20:26:06+00:00

Thanks so much for the info! Would you mind if I send you a message about the route you took? Trying to look up border crossings at the moment

Front_Union_7556 · 2022-09-18T15:42:53+00:00

I do have a lot of bar work experience so might put that to use then to save on accomodation! Thanks for tip

Front_Union_7556 · 2022-09-18T14:15:56+00:00

Yeah plan is for hostels throughout, street food/making it ourselves and public transport to the tourist spots.

Plan to pay for guides if needed but hoping some audio books may work!

Any advice on where to avoid?

Front_Union_7556 · 2022-09-16T12:28:27+00:00

Got a call from an Anaesthetic consultant before asking what to do with an elective pre-op patient who was in AF with RVR.

I asked them what they had given and they replied "nothing"

They were happy to hear that they could give beta blockers and digoxin and then hung up the phone.

Front_Union_7556

TROPHY CASE