Indications For Hematology Consultation
Indications for Hematology consultation with anticoagulant therapy:
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Initiation of therapy for patients:
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Not in critical care unit.
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Age < 30 days.
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Baseline INR ≥ 1.2 prior to initiation of warfarin.
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Impaired renal function.
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May consult Cardiology or Cardiothoracic Surgery service in lieu of Hem/Onc.
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Maintenance of anticoagulation therapy with:
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Delay in reaching therapeutic anticoagulation.
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Progression of thrombus.
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Concern for heparin induced thrombocytopenia (HIT).
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Hemorrhage and need for antidote.
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Surgery or invasive procedure in patients with:
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Mechanical/prosthetic mitral valves.
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Atrial fibrillation.
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Recent/recurrent thromboembolism.
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Use of LMW heparin other than enoxaparin.
References
David, M., et al. Heparin and LMWH in Children. Thrombosis Interest Group of Canada. January 2007. http://www.tigc.org/eguidelines/heparinchild07.htm. Accessed 11/15/08.
Lexi-Drugs Online/Pediatric Lexi-Drugs Online, Enoxaparin, http://online.lexi.com/crlsql/servlet/crlonline, Copyright © 1978-2008 Lexi-Comp, Inc, Hudson, OH 44236
Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, Vesely SK. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141: e737S –e801S.
Roach ES. Golomb MR. Adams R. Biller J. Daniels S. Deveber G. Ferriero D. Jones BV. Kirkham FJ. Scott RM. Smith ER. American Heart Association Stroke Council. Council on Cardiovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. [Journal Article] Stroke. 39(9):2644-91, 2008 Sep.
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.