No Intervention still considered after care

CCSVI After Care continues to be a hot topic in Canada, as Canadian MSers travel abroad for CCSVI Treatment and return home for follow up care. Many MSers are concerned about the lack of after care being provided and in the event of complication, how will they be treated? Stories of post-liberation patients being turned away by Canadian physicans are circulating and now the advisory committee is speaking out.

The following is an exert from the document “Guidance on Neurologic After-Care for CCSVI Procedures” by Susan Jeffrey, published on MedScape, March 21st, 2011.

“In their own new advisory document, the Alberta College of Physicians and Surgeons begins by saying that Alberta physicians have an “ethical obligation to provide follow-up care to patients who have had procedures done out of country.” However, the details of the follow-up care provided will be determined by the attending Alberta physician using his or her expertise and judgment and acting in the best interests of the patient, the College adds. Further, “the follow-up may not be the same care the patient would have received out of country.”

“They add that “Alberta physicians are NOT required to order diagnostic tests or medications requested or advised by an out of country physician. Decisions to order any tests must be made by the attending physician using appropriate clinical evidence and judgment.”

“Although it provides some guidance, the document again and again underlines the lack of evidence available for many aspects of care of these patients.
For example, in terms of prevention of thrombosis, the document states that “it is up to each individual physician to determine if they choose to accept the responsibility of continuing prescribed medications to prevent thrombosis. Without evidence to support their use, however, we cannot recommend off-label prescribing.”
Monitoring for asymptomatic jugular vein thrombosis or restenosis is not recommended, even if MS relapse or worsening of symptoms occurs.”

“Management of jugular vein thrombosis, once it is detected, depends on the clinical situation, the recommendations note. Asymptomatic jugular vein thrombosis is fairly common after jugular vein catheterization but is not routinely treated with anticoagulation. There is a “small” risk for pulmonary embolism or clot propagation, but the literature is limited. Some hematologists think the risk is higher, they note. The frequency of clot extension is unknown.”

“Therefore, in the absence of specific evidence to guide decision-making, ‘anticoagulation for a minimum of 3 months’ and ‘no treatment’ may both be reasonable options.” The imaging modality of choice is also unknown because of the lack of comparative studies, they add.”

The above is an exert from the recent address. The full text can be found at http://www.medscape.com/viewarticle/739340.

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