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Hyperhomocysteinemia is an independent risk factor for coronary, cerebrovascular, and venous thromboembolic disease. Therapy with daily folic acid supplementation has been shown to reduce the homocysteine levels in patients with hyperhomocysteinemia. Which of the following is the most appropriate step in the long-term management of these patient with Recurrent thromboembolic events?
A. Prescribe warfarin for one year
B. Prescribe subcutaneous low-molecular-weight heparin for one year
C. High dose folic acid (3 mg) per day
D. Prescribe life long warfarin therapy
E. Folic acid 1 mg per day
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tea,
thanks for posting the link.
but there too its written that long term management of recurrent thromboembolism is anticoagulant like warfarin.
folate and vitamin b12 supplimentation is for those without venous clots.
wat u think?
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PK:
Tx the cloting at the time but once it is resloves continue 3-6mo,it is done. but long term prevention is to lower homocysteine levels (key), Tx underlying condition. folate 1mg -low dose, in this case must be highest dose-3mg.
(think CHF with pulmonary edema, Tx pulmonary edema acutely, but key to prevent recurrent pulmonary edema is to Tx underlying CHF)
I found you are very thoughtful in this forum, happy to discuss with you.
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tea:
My understanding is that when one has a life long condition such as clotting factor deficiency etc that cannot be reversed shd have life long therapy.
Now in this case, folate is not the only cause of hyperhomocystenemia, so does vit. B12, Cystathaone beta synthase (CFS) , MTHFR and MS enzymes involved in the pathway of synthesis of methionine and cystathaione from homocystiene. What if one of these is responsible for the recurrent embolism. I agree wih you for the treatment of a single episode for 3-6 months. But once a clot has formed, folic acid and B12 cannot fxn.
Thanks
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that is why you need to Tx the clotting episode with warfarin or heparin or LMWH for 3-6 mo during the episode. I have never said TX clotting with folate.
