[e-drug] urgent clinical advice needed

["Drug Information Center, Manipal Teaching Hospital, Pokhara" <dicmth@fewanet.com.np>]

E-DRUG: urgent clinical advice needed
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[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