[seeker]

I have a question about DVT. My husband may have a blood clot in his leg. He went to the hospital and had a scan which came back inconclusive. They are treating him as if it were DVT. My question is...if it is DVT, will he have it indefinately? or will it go away?

Thanks!

[Stacia]

seeker, on Apr 11 2008, 01:55 PM, said:

I have a question about DVT. My husband may have a blood clot in his leg. He went to the hospital and had a scan which came back inconclusive. They are treating him as if it were DVT. My question is...if it is DVT, will he have it indefinately? or will it go away?

Thanks!

Hi Seeker,
My husband has had a couple of DVTs and as I understand it they do disolve usually. Jon is on a drug called Warfarin, and he has to have his I&R levels checked every two weeks or so.
A couple of years ago he had a clot break away and go to his lung. They called it a pulmonary embolism. He is doing fine now though. I don't know how long he will have to be on the blood thinner, but if it prevents clots, it is an easy fix.

I know his nurses check his legs every day for red or "hot" spots. He has no feeling, so when something like that is brewing, the AD is the give away.

I think the usual precautions are to avoid injury like bumps and that, and to keep the blood flowing as much as possible, which can be a problem with paralysis. Keeping the legs elevated also helps I think.

There has been a lot of info about travelers who sit for long periods in planes getting DVTs. I hope your husband gets better quickly.

Staci

[seeker]

Thanks Staci,

I just read some info on Warfarin...boy that sounds like some scary stuff. They said that if the problem was there when they scanned again next week, that Warfarin would be an option, but it's not easy getting blood from him, so they were concerned about that. Hopefully, it'll be gone. *fingers crossed*.

Jo

[Apparelyzed]

Hi Seeker,

You should find this interesting if he is going to be prone to DVT's:

Asymptomatic deep venous thrombosis (DVT) has been reported in 60% to 100% of persons with spinal cord injury (SCI). Several guidelines have been published detailing recommended venous thromboembolism (VTE) prophylaxis after acute SCI. Low-molecular-weight heparin, intermittent pneumatic compression (IPC) devices, and/or graduated compression stockings are recommended. Vena cava filters (VCFs) are recommended for secondary prophylaxis in certain situations.

Prophylactic use of vena cava filters has expanded in trauma patients, including individuals with SCI. Filter placement effectively prevents pulmonary emboli and has a low complication rate. Indications include pulmonary embolus while on anticoagulant therapy, presence of pulmonary embolus and contraindication for anticoagulation, and documented free-floating ileofemoral thrombus. VCFs should be considered in patients with complete motor paralysis caused by lesions in the high cervical cord (C2 and C3), with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulant prophylaxis. Three optional retrievable filters that are approved for use are discussed.

Conclusion:

Retrievable VCFs are a safe, feasible option for secondary prophylaxis of VTE in patients with SCI. Objective criteria for temporary and permanent placement need to be defined.


Personally, I've used compression stockings/socks for the last 13 of my 16 years post SCI, and have not had any problems with swelling feet or DVT.

However, everyone is different, and I would suggest a blood work-up, and consultation with a spinal cord injury doctor before making any decisions on the best course of action to prevent DVT's.

Also, Vena cava filters are also known as Greenfield Filters, and are widely used in the U.S.

Regards

Simon

[Stacia]

seeker, on Apr 11 2008, 06:35 PM, said:

Thanks Staci,

I just read some info on Warfarin...boy that sounds like some scary stuff. They said that if the problem was there when they scanned again next week, that Warfarin would be an option, but it's not easy getting blood from him, so they were concerned about that. Hopefully, it'll be gone. *fingers crossed*.

Jo

Hi Jo,

Yeah, I think it is rat poison! When they check Jon's I&R it is done with a finger prick and they put the blood on a strip that goes in a little machine and it tells where the blood is. They want his level to be about 2.6, but he flexuates between 1.1 and 6.7. They change his dosage all the time.

There is a little screen that they can put in his groin to keep the clots from moving up too. Talk with your Dr about it. He/she should be able to help you a lot.

Staci

[seeker]

Thanks for that Simon, I may ask about that when we go back. He has a check up appointment at Northern General on Monday, I think we'll mention this problem to them and see what they say. He has had problems with his ankles swelling and used to wear TEDS when he was up, but he has been in bed since July last year due to pressure sores. His accident was 13 years ago, and he never had a problem until I started taking care of him...makes me wonder! Just kidding. Anyway, thanks again.

Jo

[kewlcatkez]

Hi Seeker,

Tinzaparin sodium ( Innohep® and other brands of low molecular weight heparins) subcutaneous injections can be given daily for the treatment and prevention of DVT. In fact where I worked they were used as the drug of choice either to 'cover' during the instigation of Warfarin (to avoid IV heparin) or as an alternative to it, dependent upon the circumstances and situation. Individuals with a DVT or a query of one would attend the GPAU (GP Assessment Unit) sort of like a drop in, there they would have their bloods taken and if they were on Warfarin they would be telephoned and informed of how much to take. If they were on Tinzaparin sodium, they would be given the injection.

In your husband's situation, due to his SCI, it would be appropriate for the Consultant treating him for the ?DVT to consult with the Spinal Injuries Unit/Specialist.

I hope this is of some use and hope that all goes well.

(As an aside I had a ? PE when pregnant and received Tinzaparin sodium with no complications to myself or my baby).

Take care,

K

[Stacia]

kewlcatkez, on Apr 12 2008, 12:17 PM, said:

Hi Seeker,

Tinzaparin sodium ( Innohep® and other brands of low molecular weight heparins) subcutaneous injections can be given daily for the treatment and prevention of DVT. In fact where I worked they were used as the drug of choice either to 'cover' during the instigation of Warfarin (to avoid IV heparin) or as an alternative to it, dependent upon the circumstances and situation. Individuals with a DVT or a query of one would attend the GPAU (GP Assessment Unit) sort of like a drop in, there they would have their bloods taken and if they were on Warfarin they would be telephoned and informed of how much to take. If they were on Tinzaparin sodium, they would be given the injection.

In your husband's situation, due to his SCI, it would be appropriate for the Consultant treating him for the ?DVT to consult with the Spinal Injuries Unit/Specialist.

I hope this is of some use and hope that all goes well.

(As an aside I had a ? PE when pregnant and received Tinzaparin sodium with no complications to myself or my baby).

Take care,

K

You are right about the shots Kewlcakes. I amost forgot about them. Jon did get them in hospital for a while, but the Dr stopped them after about a week when he was back on the warfarin. He said they didnt like to do the injections longer than they had to. I do remember that where Jon got the injections he got lumps and brusing. They always gave him the shots in his lower abdomen maybe because his legs are very thin.

Thanks always for all your good info.

[seeker]

kewlcatkez, on Apr 12 2008, 12:17 PM, said:

Hi Seeker,

Tinzaparin sodium ( Innohep® and other brands of low molecular weight heparins) subcutaneous injections can be given daily for the treatment and prevention of DVT. In fact where I worked they were used as the drug of choice either to 'cover' during the instigation of Warfarin (to avoid IV heparin) or as an alternative to it, dependent upon the circumstances and situation. Individuals with a DVT or a query of one would attend the GPAU (GP Assessment Unit) sort of like a drop in, there they would have their bloods taken and if they were on Warfarin they would be telephoned and informed of how much to take. If they were on Tinzaparin sodium, they would be given the injection.

In your husband's situation, due to his SCI, it would be appropriate for the Consultant treating him for the ?DVT to consult with the Spinal Injuries Unit/Specialist.

I hope this is of some use and hope that all goes well.

(As an aside I had a ? PE when pregnant and received Tinzaparin sodium with no complications to myself or my baby).

Take care,

K

They sent home a weeks (actually 12) supply of the Innohep 20,000 for me to give him...although it makes me squirm to do it. This morning the swelling was gone when I turned him over, but it may return with him being on his right side (the swelling was/is in his left thigh). He is also taking an antibiotic in case it is an infection (cellulitis). I'll let you know how the second scan goes next Thurs.

[lune14]

Approximately two years ago I developed bi-lateral DVT's from mid thigh to my ankles. The ultrasound showed a severe enough situation that I was sent immediately to ER and for about a week or so I was given Lovenox shots in the abdomen. After the Lovenox routine I was placed on a daily Warfarin regimen and do a monthly INR (not I&R by the way) reading, which basically reads the rate at which your blood clots. INR stands for International Normalized Ratio, also referred to as "Prothombin Time or Pro Time"

I have since had to wear compression socks which I had never used in the past. My doc feels that I will be a 'lifer' on Warfarin, which I'm not too happy about but the risk of clotting is too great for me now. I do worry about bleeding but am very careful. I haven't experienced any bad bruising but I keep a close eye on the limbs.

[Stacia]

lune14, on Apr 14 2008, 07:54 AM, said:

INR (not I&R by the way) reading, which basically reads the rate at which your blood clots. INR stands for International Normalized Ratio, also referred to as "Prothombin Time or Pro Time"

You learn something new everyday if you pay attention. Excuse my ignorance.

[lune14]

no worries... I thought the same thing when I first heard it ;-)
Just thought it might help to know.

[E-DOG]

Due to a gun shot wound back in the late 80's (destroyed femoral vein) I've had a vena cava filter in place. I've never had a problem with it. Back in the life I'd occassionaly get a clot in the afore mentioned leg, and if some of it broke off and made it to the filter, it would mess with my circulation for a while. But they do disolve, a few weeks?? I was given coumidin, also an anti coag med. Most of those meds. while reducing the blood clot threat, won't turn you into a hemophiliac so don't sweat that.

Once in a while it's good to get an x-ray of said filter, making sure of structural integrity.

Course every time I get an M R I, I forget to tell the tech about it and the damn thing tears its way out of my chest and sticks to the inside of the machine, but so far they've gotten me to an E R on time and I rarely lose more than six or eight pints of blood. (Jezus, am I full of it or what!!)
The info above my ridiculous meanderings is true though.

VCfilters are non threatning and are kinda fun to have placed. (guess I just love any kind of attention) so fear not.

Don't sweat the small stuff, and remember it's ALL small stuff.
e-dog

[Emily C]

Hi...
I'm a high risk of clots b/c of multiple conditions, so I've STILL waiting for my "pumps". It's been a few months now. Medicare didn't want to pay, so we sent 2 or 3 letters of med. nec. and they finally relanted.(sp)
I STILL have to wait TWO more weeks...my doc wants them on me 24/7 unless I"m in my chair which I'm trying to still get!!
Take care and God bless u and your hubby. BTW, if u have Medicare/aid, be careful how they phrase the letters of med. nec. ONE wrong word can be a problem!!

This post has been edited by Emily C: 18 April 2008 - 01:46 AM

[Char]

I have been a paraplegic for 17 years (T12) and in wheelchair. I just underwent a spinal/pelvic fusion a few weeksago to remove the old rods, place new rods and fuse spine to pelvis to straighten out scoliosis and pelvic obliquity. I developed blood clots 17 years ago during my initial surgery and rehab. I have been on aspirin a day since. During this recent surgery, I had to stop using aspirin. A vena cava filter was placed in me to catch any clots that may develop and move. I saw the surgeon today. He advised against going back on aspirin and told me there was no reason not to leave the filter in place for life. I have one week to make a decision before the filter removal will not be available. I am not sure as to what to do. Should I leave the filter in for good? What are the longterm risks and complications? If I develop a clot that is caught by the filter, how will I know it is there? Does anyone have any long term experience with the filters? Please advise.....