J Spandorfer

Thomas Jefferson University, Filadelfia, Pennsylvania, United States

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Publications (5)66.83 Total impact

  • John M Spandorfer · Susan Lynch · Howard H Weitz · Scott Fertel · Geno J Merli ·
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    ABSTRACT: Warfarin is used to either treat or prevent thromboembolism; currently >1 million people are taking this anticoagulant.(1) Patients maintained on warfarin may occasionally need to stop their anticoagulation during invasive procedures. All techniques to manage anticoagulation during procedures may be problematic.(2-4) After stopping warfarin, unfractionated heparin, either high-dose subcutaneous or intravenous, may be started once the international normalized ratio (INR) becomes subtherapeutic. Either form of heparin requires monitoring and often several adjustments before becoming therapeutic. Moreover, most physicians prefer intravenous heparin to be given in the inpatient setting, thus increasing costs. Another approach is to lower the dose of warfarin by approximately one third and perform the invasive procedure when the INR is approximately 1.5. The INR can also be lowered by adding a small dose of vitamin K. This method, however, may carry an increased risk for bleeding, even for less vascular procedures. Also, the use of vitamin K may lead to temporary warfarin resistance. A last option is to hold warfarin 4 to 5 days before the procedure and not to use any anticoagulant until the postoperative period. However, this method may carry a risk for thrombotic complications. The use of enoxaparin may avoid these limitations. It can be given subcutaneously and therefore does not require hospitalization perioperatively. Reports show that low molecular weight heparin, such as enoxaparin, is at least as effective and safe as unfractionated heparin in the prevention and treatment of thrombosis.(5,6) This report details our experience to date using enoxaparin for chronically anticoagulated patients.
    The American Journal of Cardiology 09/1999; 84(4):478-80, A10. DOI:10.1016/S0002-9149(99)00341-0 · 3.28 Impact Factor
  • Source
    J Spandorfer · G Merli ·

    New England Journal of Medicine 10/1997; 337(13):938-9; author reply 939-40. DOI:10.1056/NEJM199709253371314 · 55.87 Impact Factor
  • John M. Spandorfer · Geno J. Merli ·
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    ABSTRACT: Increasingly, primary care providers are caring for patients who require anticoagulation. In this article the indications for, complications of, and methods of dosing and monitoring warfarin in the outpatient setting are reviewed. Heparin use among ambulatory patients also is discussed.
    Medical Clinics of North America 04/1996; 80(2):475-91. DOI:10.1016/S0025-7125(05)70449-1 · 2.61 Impact Factor
  • G J Merli · J Spandorfer ·
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    ABSTRACT: Approaching the patient with unilateral leg swelling presents a challenge to the physician in ambulatory practice. Contributing to the difficulty is the lack of studies that have assessed a population of patients presenting with unilateral leg swelling. The purpose of this article is to discuss unilateral leg swelling with respect to the chronicity of the presentation and the most common differential diagnoses based on a review of the current literature and personal clinical experience.
    Medical Clinics of North America 04/1995; 79(2):435-47. · 2.61 Impact Factor
  • Geno J. Merli · Linda Robinson · John Spandorfer · Richard Paluzzi ·
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    ABSTRACT: Ulcers of the lower extremities are a common problem in ambulatory care. Patients with lower extremity ulcers tend to be treated by physicians in a variety of specialties which often opens their care to a multitude of interventions. It has been estimated that between 400,000 and 500,000 people have had leg ulcers in the United States.1 The prevalence of disease requires accurate assessment and management strategies in light of managed care constraints on health care dollars. The purpose of this article is to review the differential diagnosis of lower extremity ulceration and the approach to its assessment.
    Clinics in Dermatology 01/1994; 12(1):11-7. DOI:10.1016/0738-081X(94)90252-6 · 2.47 Impact Factor