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[e-drug] urgent clinical advice needed

E-DRUG: urgent clinical advice needed
-------------------------------------
[This message, however urgent for the doctor and patient, is probably not 
suitable for E-drug, but more for a clinical forum. Anyone who knows of such a 
'medical' forum where there is a willingness to help colleagues in low-resource 
settings? WB]

sir, 

I need urgent information regarding a patient(49 yrs) who has presented with 
acute anteriro wall myocardial infarction within 6 hours of pain. he has had 
double valve replacement and is on acitrom since 3 years (is not in AF). 
however inr <1.6. we are supecting a possibilty of valvular thrombus (echo out 
of order). should this patient be thrombolysed (there is no other 
contraindication). if so, post thrombolysis should we put the patient on LMWH? 
if not to thrombolyse what regimen to use- asp+ lmwh....

thanks,

regards,

abhishek, MD
dept of medicine,
mth , pokhara , 
Nepal
dicmth@fewanet.com.np

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