Part 16: Miscellaneous
Where can I find an expert in the field?
- Depending on your individual situation, an “expert” in the field can be any of several different people:
- If an individual needs someone to monitor warfarin therapy, an “expert” would be a provider in a dedicated anticoagulation clinic. You can find a list of anticoagulation clinics designated by region at the Anticoagulation Forum Web site (www.acforum.org).
- Most pediatricians who take care of children with clots are trained as pediatric hematologists and will be located in a university or other major medical center. They would work with a local pediatrician to manage the child’s warfarin therapy.
- If the patient is a woman who is pregnant or thinking about becoming pregnant, she should see an obstetrician who specializes in high-risk pregnancies. Obstetricians with experience in the care of women with thrombophilia or a history of thrombosis are more likely to be affiliated with hemostasis and thrombosis referral centers.
- If the individual has an inherited thrombophilia or is interested in being tested for an inherited thrombophilia, he or she should see a provider who specializes in thrombophilia. This provider could be a hematologist, a cardiologist, a pulmonary specialist, or a general internist, depending on the particular community. A genetics counselor could also provide useful insights into inherited thrombophilia.
- If a patient on chronic anticoagulation needs a surgical procedure, a team approach is important: the surgeon must work with the providers who will manage the anticoagulation therapy. In some cases, a patient might need low-molecular-weight heparin while warfarin is stopped, or possibly placement of an inferior vena caval filter, which needs to be coordinated with the surgeon.
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