Fragmin (heparin) and cerebral bleeds/headache

[Jay-Jay, RN]

I have a patient right now who's on total bedrest for 6 weeks following dislocation of her hip after hip replacement surgery. She's on Fragmin (low molecular wt. heparin) as prophylaxis agains blood clots. She has a history of migranes, and has had a headache for the last 5 or 6 days! Her MD does NOT do housecalls, I have not been able to get ahold of her surgeon, and the haematologist who ordered the Fragmin was very abrupt with me, and suggested I send her to emerg. He gave me no help whatsoever in figuring out if the headache was due to a migrane or something more serious. Except for the headache, and an elevated pulse (98) she seems fine to me. She's young (40's) has no elevated BP (BP is 105/60). She's on Plaquinil (quinine derivative) for lupus, and that can cause problems with the blood (thrombocytopenia, agranulacytosis).

Arrgh. Spent a good part of the day on the phone trying to get some help from her doctors and got next to NOWHEERE! Finally got her MD to order some bloodwork, plus, she says the headache has at last gone away. Anyone care to play doctor for this one, in the absence of the medical profession?? I'VE got a headache now, from worrying about this!

I did have a pt. on fragmin about a month ago who DID have a cerebral bleed, but she reported feeling "just awful", had blurred vision, dizzyness, AND an elevated BP/broadened pulse pressure. This lady has none of these symptoms.

[Jay-Jay, RN]

Wildtyme:

The headache is back today. She did not go to ER because she CHOSE not to go, also she would have had to go by ambulance, as she's unable to weight bear, or even sit up (can't bend her hips more than 40%).

There were no obvious neurological deficits, unequal pupils, or even nausea/vomiting. All she had was mild photophobia, and the pain responded somewhat to Tylenol and Darvon. The most worrisome feature of the headache was its persistence (6 days).

One good thing that has come of this is she plans to fid a new G.P. He treated me in an abominable fashion when I phoned him yesterday. He said he knew absolutely nothing about fragmin, and did not even know that she'd been in the hospital. His whole attitude was: "Why are you bothering me??"

Yes, the E.R. would have been the safest route to go, but now you know why they're seriously overcrowded....MD's who refuse to be accessible to their patients when they need them the most. This whole thing could have been solved over the phone in 5 minutes by a physician willing to listen and ask intelligent questions about the client's medication and symptoms.