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Suggest Treatment For Large Plural Effusion With Complete Whiteout Of The Left Lung
Question: Hi,
My brother has a LARGE plural effusion with complete whiteout of the left lung. He cannot have a thoracentsis performed as his INR level is too high. He has had this for at least a month. What should be done about this as his GP isn't doing anything to alleviate this situation?
My brother has a LARGE plural effusion with complete whiteout of the left lung. He cannot have a thoracentsis performed as his INR level is too high. He has had this for at least a month. What should be done about this as his GP isn't doing anything to alleviate this situation?
Brief Answer:
Reverse INR below 2.5 and consider IR tap
Detailed Answer:
Dear patient,
Thanks for the query. With such large effusions that may be causing symptoms of shortness of breath, pain, etc, the mainstay is a thoracentesis for therapautic and diagnostic reasons; usually, except if the indication for anticoagulation is a mechanical heart valve, then warfarin can be held or a bit of Vitamin K can be given to reverse INR below 2; Interventional Radiologists are also comfortable doing ultrasound guided biopsies with INR below 2.5.
Hope that helps, wish you the best,
Dr Brenes-Salazar MD
Mayo Clinic MN
Department of Medicine
Division of Cardiovascular Diseases
Reverse INR below 2.5 and consider IR tap
Detailed Answer:
Dear patient,
Thanks for the query. With such large effusions that may be causing symptoms of shortness of breath, pain, etc, the mainstay is a thoracentesis for therapautic and diagnostic reasons; usually, except if the indication for anticoagulation is a mechanical heart valve, then warfarin can be held or a bit of Vitamin K can be given to reverse INR below 2; Interventional Radiologists are also comfortable doing ultrasound guided biopsies with INR below 2.5.
Hope that helps, wish you the best,
Dr Brenes-Salazar MD
Mayo Clinic MN
Department of Medicine
Division of Cardiovascular Diseases
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My brother's PA turned his situation over to a "pulmonary specialist" who checked
his INR level on a Monday in his office and it he was told the reading was, "OFF THE CHART's" HIGH - no test result number was given to him.
He was started on lovonex injections and was told to come back in 2 days, Wednesday of that same week, which he did. On that next appt his INR was 3.1 and he was told to come back in 5 DAYS and that doctor didn't change his injections, increase vitamin K or do anything else that would make his INR drop sufficiently so that his could have the
thoracentesis performed. MY BROTHER DIED IN MY ARMS THE VERY NEXT DAY.
I NOW know that had he been given vitamin K and blood products that would have brought down his INR and he could have had the fluid removed. Would you please give me your opinion on the situation? I have spoken with both his PA and the pulmonary doctor and the pulmonary doctor said "he could have been taken to a larger hospital where they would have a chest surgeon to assist if there would have been a bleeding problem. My heart is broken in a million pieces. Would you PLEASE give me your opinion.
Thank You.
his INR level on a Monday in his office and it he was told the reading was, "OFF THE CHART's" HIGH - no test result number was given to him.
He was started on lovonex injections and was told to come back in 2 days, Wednesday of that same week, which he did. On that next appt his INR was 3.1 and he was told to come back in 5 DAYS and that doctor didn't change his injections, increase vitamin K or do anything else that would make his INR drop sufficiently so that his could have the
thoracentesis performed. MY BROTHER DIED IN MY ARMS THE VERY NEXT DAY.
I NOW know that had he been given vitamin K and blood products that would have brought down his INR and he could have had the fluid removed. Would you please give me your opinion on the situation? I have spoken with both his PA and the pulmonary doctor and the pulmonary doctor said "he could have been taken to a larger hospital where they would have a chest surgeon to assist if there would have been a bleeding problem. My heart is broken in a million pieces. Would you PLEASE give me your opinion.
Thank You.
Brief Answer:
Deeply sorry
Detailed Answer:
I am deeply sorry about your loss, my most honest condolences. In retrospective and again I do not have all the clinical details, I agree with the PA that a referral to a tertiary center with surgical backup to perform an Interventional Radiology procedure could have been considered, but given his rapid decline, probably the effusion was likely a consequence of the underlying process that caused his death, rather than the primary cause. It may have been an aggressive malignancy for example.
Our expectation is that he is in peace, in a better place, where there is no pain, sorrow or disease.
Truly yours,
Dr Brenes-Salazar
Deeply sorry
Detailed Answer:
I am deeply sorry about your loss, my most honest condolences. In retrospective and again I do not have all the clinical details, I agree with the PA that a referral to a tertiary center with surgical backup to perform an Interventional Radiology procedure could have been considered, but given his rapid decline, probably the effusion was likely a consequence of the underlying process that caused his death, rather than the primary cause. It may have been an aggressive malignancy for example.
Our expectation is that he is in peace, in a better place, where there is no pain, sorrow or disease.
Truly yours,
Dr Brenes-Salazar
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You Dr Brenes-Salazar for your medical info and your kind words.
It gives me comfort knowing that he is in a better place as you have said. No more pain and suffering.
Again, Much Thanks
It gives me comfort knowing that he is in a better place as you have said. No more pain and suffering.
Again, Much Thanks
Brief Answer:
God speed
Detailed Answer:
May God XXXXXXX peace to you and your loved ones at this time.
Best wishes
God speed
Detailed Answer:
May God XXXXXXX peace to you and your loved ones at this time.
Best wishes
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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