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Suggest Treatment For Pulmonary Emboli 6 Weeks After Gallbladder Surgery

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Posted on Tue, 16 Dec 2014
Question: I had pulmonary emboli 6 weeks after gallbladder surgery in Sept of 2013. I tested positive for MTHFR heterozygous C6667 and heterozygous c1298. Also my LP-PLA2 is very elevated at 280. My hemotologist says this isnt a big risk factor for clots and to take a baby aspirin daily and will be on lovenox if I have any other surgeries. In your opinion is this what should be done? In need of a good second opinion.
Thanks
doctor
Answered by Dr. Dr.N.Senduran (5 hours later)
Brief Answer:
I accept your hematologist's view..

Detailed Answer:
Hello there,

I am Dr.Senduran,General physician hope to answer your query.

I accept the view of your doctor hematologist that baby aspirin should be enough for prophylaxis of thromboembolism in your case because of the following reasons..

Both MTHFR mutation and increased LP-PLA2 levels are independent risk factors for atherosclerosis and not the thrombosis directly..

1)Individuals with positive MTHFR mutation(Heterozygous state) can have near normal homocysteine levels unlike homozygous for MTHFR --->You can get checked for homocysteine level periodically...

2)Increased LP-PLA2 level doesn't enhance formation of thrombosis directly..In fact,it is one of the enzymes that degrade platelet activating factor(PAF)...

Hence if you don't have any other risk factors for coronary heart disease like smoking,hypertension,obesity etc,there is no need for regular use of anticoagulants like warfarin etc for prophylaxis of thrombosis..

Antiaggregants(like Baby aspirin) would be enough..During and post surgery,anticoagulants should be the choice..

Hope this helped you..Further queries are welcome.

Take care.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Dr.N.Senduran

General & Family Physician

Practicing since :2011

Answered : 407 Questions

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Suggest Treatment For Pulmonary Emboli 6 Weeks After Gallbladder Surgery

Brief Answer: I accept your hematologist's view.. Detailed Answer: Hello there, I am Dr.Senduran,General physician hope to answer your query. I accept the view of your doctor hematologist that baby aspirin should be enough for prophylaxis of thromboembolism in your case because of the following reasons.. Both MTHFR mutation and increased LP-PLA2 levels are independent risk factors for atherosclerosis and not the thrombosis directly.. 1)Individuals with positive MTHFR mutation(Heterozygous state) can have near normal homocysteine levels unlike homozygous for MTHFR --->You can get checked for homocysteine level periodically... 2)Increased LP-PLA2 level doesn't enhance formation of thrombosis directly..In fact,it is one of the enzymes that degrade platelet activating factor(PAF)... Hence if you don't have any other risk factors for coronary heart disease like smoking,hypertension,obesity etc,there is no need for regular use of anticoagulants like warfarin etc for prophylaxis of thrombosis.. Antiaggregants(like Baby aspirin) would be enough..During and post surgery,anticoagulants should be the choice.. Hope this helped you..Further queries are welcome. Take care.