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On acitrom after small intestine surgery. Getting headache and feeling breathlessness. What to do?

Sep 2012
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General & Family Physician
Practicing since : 2008
Answered : 1416 Questions

I am XXXXXXX in Lucknow. I am fiftyone yrs old, about six years back i started having headaches on left side and subsequently breathlesness which became serious my doctors examined me for heart prob and even had engiography done but no blockade was found but during engio it was observed that blood supply in small artries was erratic i was then given nicoraldil which gave me relief for few months after that further duagonsis was done and i was found to be defecient in protien c &s and since then i was put on acitrom which gave me lot of relief in pain as well as no attack of breathlessness occured. I was taking 2mg five days and 1mg for two days i.e tuesday and saturday and montiored INR at 2 for three yrs but after that montering was not done as readings were same.
In oct i had hemmorage in small intestine and had to go for emergency surgery wherein ten inches of small intestine was removed. Now my doctors have stopped asitrom but after six weeks of surgery i have again started having headaches and also cramps in my calf. Pls advice what to do.

My email id id YYYY@YYYY
Posted Fri, 14 Dec 2012 in Headache and Migraines
Answered by Dr. Das Arindam 53 minutes later
Thank you for posting a query.

Firstly, protein c and S deficiency leads to increased chance of coagulation of blood. It leads to many symptoms like you have already described.

The main target in this disease condition is to decrease the coagulation power of blood by decreasing the other coagulation factors. This anticoagulation therapy may lead to side effects like bleeding. This side effect can be avoided by doing P-time and INR regularly.

For this purpose, some anticoagulant agents are given. But, in this treatment P-time and INR have a special value. It indicates the coagulation profile status. According to levels of these parameters, the doses of the drugs are to be maintained.

Though you have experienced an emergency situation, still you have to go with the anticoagulant agent. As, already 6 weeks passed, after having normal P-time report, anticoagulation therapy can be reconstituted. BUT most importantly you have to monitor the P-time and INR regularly.

Now, about the drugs. As you have a history of bleeding, you have to take any anticoagulant agent. Consult with a cardiologist for prescribing a suitable anticoagulant agent in low dose. Except this Acenocoumarol, you were taking, some other drugs like warfarin can also be used, which is a much safer drug.

You should also consult about the ecosprin. Ecosprin is also an anticoagulant agent. As you have a bleeding history, consult about its suitability. In my opinion, only one anticoagulant agent is sufficient considering your situation.

So, consult with a cardiologist for further management.

Hope this information suffices. Let me know, if you have any more question.

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