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Doctors' Answers to "Frequently Asked Questions" - Thrombosis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 03/9/2000]
Question: I am a 27 yr. old female and was recently hospitalized for blood clots in the leg following an injury and surgery (I broke my ankle in 3 place and had 3 screws put in). My whole leg was clotted from the ankle to the groin. I was told that the clots were a result of the trauma and the surgery and were kind of unusual for my age. I am currently taking birth control pills and was told that after I get off of the coumadin, that I should not take the pill anymore. I do know that taking the pill does have an increased risk of blood clots, But if the clot was kind of a freak thing and was directly a result of the injury etc. then should I really have to get off of the pill? This bothers me because I can't imagine having to use other forms of birth control. Thank you.

Answer: Since you are so young, most would recommend that you be screened for inherited disorders of coagulation. This would be especially so if anyone else in the family had venous or arterial clots in their life. Sometimes strokes or heart attacks would present this way especially in younger adults with less risk factors. There are several tests to be done and most general internists and/or hematologists can easily check them. Not cheap, but most physicians think that the mechanism of clotting on bcps is due to changes in coagulation factors in the liver induced by the bcps. As to avoiding bcps, most physicians would not give you these drugs with this history. But, the exact risk is hard to know given the circumstances. If you had a completely normal vkings doppler(meaning good flow in the affected leg without scarring)it might be considered. But risky.

[posted 03/2/2000]
Question: I had surgery in 1997 to repair a tear in my left leg(quadricep). Aproximately 3 months later I developed and neglected a blood clot. A DVT. I was hospitalized and given Heprin. I was put on Coumadin and I am still on it. Will I have to be on it for life? Are there herbs to take as an alternative? I have read about Horse Chestnut. What is a greenfilter and can it help me? I had a venus dopler about a year ago and the clot was still present, although reduced.

Answer: Unless there is an underlying mechanism causing the recurrance of clots, most physicians would stop the coumadin after six months regardless of whether there is residual clot on the ultrasound. There will be a risk of reoccurance with this, less if you take an aspirin once a day, but acceptable considering the risk of coumadin for bleeding. If you have a reoccurance off the coumadin, most would recommend long term coumadin. Horse chestnut is for chronic venous stasis , I have not seen studies on DVT per se. A greenfilter is placed in the inferior vena cava to stop the clots from migrating to the lung. This is used in patients who cannot use coumadin(immediately post neurosurgery for example). If you have not had a pulmonary emboli, of little use currently.

[posted 01/26/2000]
Question: I am a 27 yr old male with a healing blood clot in my thigh. The cause of this clot is unknown to my internist and we cant't find out until 5 months from now when I am off the Coumadin. About 3 weeks before the clot, I pulled a muscle in the calf of the opposite leg where the clot is today. In the calf there was visual bruising and some swelling accompanied by soreness and pain. I limped around on it for about 4 or 5 days. Soon after (about a week) I thought I had healed from the muscle pull the same calf had moderate swelling along with the ankle(in retrospect we feel was a blood clot too). There was no pain, as if I had re-injured my calf, accompanied by the swelling. Remember this is the opposite leg of the present clot. So I remained on crutches and imobilized until the swelling subsided which took about 9 or 10 days. While imobilized I started to feel sore in the groin area of the opposite leg, consequently resulting in the blood clot. I am not overweight, no long trips, no family history of this,and no severe trauma. Could the "trauma" of the pulled muscle have caused the clot in the opposite leg or was it the imobilization. My internist says " If clots were caused by brief imobilization (10 Days)then everyone who got the flu would get a blood clot" I feel very confident in my doctor as he was recommended to be one of the best internists in the state.

Answer: Considering your age, I would look for medical conditions that would predispose to clots. These would be Protein C Deficiency,Protein S Deficiency, Homocysteine(too high), Factor V Leiden Deficiency, Antithrombin III Deficiency, and Lupus Anticoagulant. If these are normal, I would take an aspirin once a day unless you develop gi toxicity. Discuss it with your md. These are uncommon problems, but usually seen in young patients with clots for less than classic reasons(sound like you?).

[posted 11/1/1999]
Question: I am a 33 yr old female currently being treated w heparin w hist of dvt & phlebitis. I have lived with this condition for 11 yrs and know the feelings associated with in my legs. For the past 2 wks I have had severe pain in my lower left leg. Have seen 2 OBGYN's regarding pain & have had a venous duplex (ultrasound) done on both legs to check for blood clots. No clots were found. Technician and one of the OBGYN's suspect pain is located where my achilles tendant is. My own OBGYN thinks may be a new vein "acting up". My intincts are telling me it's something different. After researching any info I could find under achilles tendenitis, I show same symptoms... such as pain lessens when I conitinue to walk and worsens when I elevate or rest, then try to walk. Pain seems to be worse later in day & evening. I am pregnant and EDD is mid Nov, so I do not do any strenuous exersise or athletics. Almost forgot, I do have what seems to be a lump or bump about 4-5 inches above heel in back of leg. Pain started there, now is radiating to ankle and up the left side of my leg, about 2/3 up my left calf. I am getting increasingly worried and with my history of DVT, I feel I can never be too careful--please help. thank you

Answer: Phlebitis below the knee is a nuisance but will not be fatal. Phlebitis above the knee is a different story. This sounds like tendonitis, but some patients with phlebitis will have similar histories. You can wait to deliver or see an orthopedic surgeon now. However, I doubt you would take any of the drugs they would recommend until you have delivered. Good luck with the delivery. Also, ensure you have been checked for the inheritable disorders of coagulation -simple blood tests which can be passed to your children.

[posted 08/18/1999]
Question: I am a 24 yr. old female who is in good health, active, and athletic. I developed a blood clot in my leg after trama to the area from a sports injury. The diagnosis came after seeing four different doctors with a stay in the hospital due to a piece breaking away from the original clot traveling to my lung. The process for diagnosis took six weeks. From what I am told my case was severe. Can you tell me if the lenght of time from a blood clot forming to diagnosis correlates with the amount of damage sustained? I am told I will take coumadin for at least the next six months. When I am finished with that medication, what kinds of tests should my doctors be doing to determine if I have a blood condition? And I am also concerned about post-phlebitic syndrome. I know treatment is limited. What kinds of treatment work best for controlling this syndrome?

Answer: The severity of the problem(thus leading to post phlebitic syndrome depends mainly on the size of the clot in your leg. Since the clot grows over time, delay in diagnosis can lead to this problem-but occasionally present with no delay. Due to your age, the doctors should check the inherited disorders of clotting that can lead to this. These would be Factor V Leiden Deficiency, lupus anticoagulant, anti-thrombin III deficiency, Protein S deficiency, Protein C deficiency and homocysteine. Especially if anyone in the family had any type of clot(stroke, heart attack, etc.) these should be checked. Expensive but important in a young person to prevent further clots in the future.

[posted 09/28/1999]
Question: My mother just recently had a greenfield vena cava filter implanted. The doctors deemed this necessary after finding a blood clot in her pelvis, and a few emboli in her lungs....she had been on heparin shortly after they found the clot in her pelvis. She was told at first she would need to be on coumadin for about 6 months, now they tell her it will be necessary to take it for the rest of her life. She is not elderly (only 47) and walks daily, so inactivity is not a problem. She also currently has a colostomy bag due to complications of another surgery. She is schuduled for reversal in 3 weeks. My questions are: is it really necessary for her to be on coumadin for the rest of her life and should she be taking blood thinners before this upcoming major surgery?

Answer: Depends a lot on why the doctors thought she should be on coumadin, that is what was the cause of the clot? The filter will work to "catch " emboli from below,although after a few years there are reports of bypass veins growing and allowing repeat emboli. I'll need to know the reason for the emboli. As to the surgery, it should be stopped 4-6 days prior to surgery.

Question: Can you tell me what Thrombocytopenia is and how it is caused? Also, can you tell me what happens if you get a severe or minor bruise or cut and you have to desise?

Answer: Thrombocytopenia is a low platelet count. Platelets are produced by the bone marrow and usually run 150,000 to 300,000. A low count is usually under 100,000, although some use 50,000. There are many causes of low platelets. There are many diseases which cause the problem. I'd refer you to Harrison' s Principles and Practices of Medicine(available in most libraries) for a more detailed list. The causes range from diseases like lupus to drugs, to viral infections to Idiopathic(unknown) causes. Many blood disorders will cause this problem also.

Question: I come from a big family. My father has had deep vein thrombosis several times. He is an active man. One time it was the result of surgery and he survived. However, my 26 year old sister died from a saddle embolism very unexpectedly. She was somewhat overweight and took the birth control pill. I also had an aunt who died of a pulmonary embolism as well. Is there a some kind of genetic flaw in our family? What can I do to assure myself that this will not happen to me or anyone else in my family again. What type of test should I have done if you recommend that route?

Answer: There are several inherited causes of thrombosis and you certainly have a family history that could be affected. Tests need to be done by your internist to check Protein C, Protein S, Antithrombin III, homocysteinuria, and lupus anticoagulants. Those are the current deficiencies that could result in excess clotting. If you do not have the problem, others in your family should be checked.

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