Coagulation tests results should be normal, and the patient should not be taking Coumadin. Coumadin may be discontinued and replaced with enoxaparin sodium (Lovenox; Rhône-Poulenc Rorer Pharmaceuticals, Inc., Collegeville, PA), given once or twice a day on an outpatient basis. Coumadin may also be stopped and replaced with heparin, but this medication must be administered intravenously, requiring hospital admission. Both enoxaparin sodium and heparin can be reversed with protamine sulfate before PV and restarted postoperatively. Aspirin use is not a contraindication to the procedure.
PV is not recommended for patients with signs of active infection, but elevated white blood cell counts clearly associated with medical conditions such as myeloma or secondary to steroid use are not contraindications.
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