Relative has Deep Vein Thrombosis

Miscellaneous and Personal Stuff I Must Share
1

Hiya’ll (card carrying) teeming millions…

My sister has been told she’s now got DVT following a very recent knee operation. I’ve looked on netdoctor to see what happens and all it tells me are the potential causes etc - the usual stuff - but not what can happen to people afterwards.
She’s been put on warfarin, the rat poison. It’s also used by the NHS to to allow the blood clots to move freely I guess. She’s got about 3 months of injections to take now and is off work longer than the expected ammount of time.

What good will warfarin do?
What are the long term implications of DVT?
Any personal experiences?

2

IANAD, but I’ve worked for companies in the cardiovascular device biz, so I’ll tell you what I know.

Warfarin is a blood thinner (take too much and you bleed out everywhere, which is why it’s used as rat poison). It’s given to try to dissolve the clot. Incidentally, it got it’s name from WARF, the Wisconsin Alumni Research Foundation. They take research that’s done at the University of Wisconsin, get it patented, keep some of the licensing fees, give some to the inventors, and funnel the rest back into research at the UW. The guy who discovered/invented warfarin got research funds from WARF.

One danger with DVT is that clots will break off. When this happens, they’ll travel through the venous system, go to the right side of the heart, and then get stuck in the lungs. When that happens, it’s called pulmonary embolism. It’s not as dangerous as blood clots in the arterial system (which can cause heart attacks or strokes), but it’s not too fun.

One possible mode of treatment is to install a filter device in the vena cava (the big vein that empties into the heart). This can be done somewhat noninvasively–a catheter will be run from the femoral vein up to the vena cava and the filter device is deployed through it. The idea is to trap clots before they can get to the heart, hence before they get to the lungs. This is often done if the patient can’t be put on blood thinners (for instance, a relative of mine was having intestinal bleeding at the same time she had DVT. Putting her on blood thinners would have exacerbated her intestinal bleeding, so the next option was a filter device).

3

IA also NAD, but I had DVT as a postsurgical complication of leg surgery.

Warfarin is powerful stuff, and sometimes very difficult to regulate the dosage; at first my doc was testing my blood clotting time (“pro time”) every couple of days, and would adjust my dosage of coumadin (the tablet form of anticoagulants, after they released me from the hospital) anywhere from 1 mg/day to 10 mg/day. Lots of things can affect blood clotting times, from level of physical activity to diet (particularly grapefruit juice and Vitamin K, often found in green leafy vegetables). It was really weird to have my doctor tell me NOT to eat green, leafy vegetables. Same goes for any medication containing hormones; I had to argue with my doc before she would let me use birth control pills again, and she wouldn’t do it until I was long off the coumadin and had regained some mobility after the leg surgery. It was no fun, let me tell you.

If your sister’s doc hasn’t already told her this, she should be very careful to watch for bruising, as it is sometimes a sign that she is bleeding too much and her dosage may need to be adjusted. They will probably monitor her very carefully. Also, they have probably told her to avoid any other medicines that may affect blood clotting times, such as aspirin and other anti-inflammatories.

Warfarin and other anticoagulants are scary stuff, but they can save your life, too. Who knows what might have happened to me if the physical therapist hadn’t picked out the real reason for my knee pain? I might be dead of a pulmonary embolism.

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She may want to ask her doctor about getting tested for a couple of common genetic defects that can predispose her to DVT. Specifically, the Factor V Leiden and/or the Prothrombin (AKA Factor II) G20210A mutations. Of course, I’m biased because I do dozens of those tests every day at work.

It may not be necessary in her case, because what with your sister’s surgery, there’s probably not much question as to why it happened, but it’s probably worth asking about.

5

My Grandmother had DVT twice, both times after long flights.

The first time, she collapsed in the street. The doctors put her on warfarin and she started bleeding internally. She was in huge pain and told the night nurse. The night nurse didn’t pass this info onto any doctors because she thought she was going to get into trouble. In the morning half of my grandma’s torso had gone purple from bleeding and the doctor saw and went into emergency mode. She ended up being in hospital 6 weeks.

When she wanted to travel again the doctor gave her two injections to take, but she still got DVT again. It was a lot less dangerous the second time because she noticed her leg swelling up and we got her to the doctor for x-rays and then to the hospital really quickly. They started her on really low warfarin because she reacted so badly last time.

Okay, story time: My Mum used to work at the particular hospital my Grandma went into, and one day when she was visiting Grandma she decided to go up and say hi to her friend that still works there. When she was there she got talking to a doc she knew and it turned out he was doing research on DVT, and he asked Mum if Grandma would be involved. Of course she said yes, and so was sent off for X-rays.

The X-rays came back, and within two hours she was in surgery getting a filter put in because a bit of clot was about to break off. (This meant she couldn’t do the study unfortunately.) Like has been said before, if the clot breaks off and goes into the heart, the patient will most certainly die. So, Grandma was REALLY lucky. If Mum hadn’t gone up to visit her friend and seen the doc (etc), she would be dead.

So, yeah… Anyway, when she first got out of hospital, Grandma had to wear pressure stockings, which are really tight. She had to get her blood tested twice a week to regulate the warfarin levels. (The blood test people ring her up and tell her how much to take.)

It’s around 6 months later now, and she only gets blood tests around every two weeks now, or once a month, but she is still on warfarin. Her GP said she will probably be on warfarin for the rest of her life (she is 87), and she isn’t allowed to fly for more than 2 hours.

She was never told not to eat certain things, only that the fewer other medications she takes the better.

Anyway, that’s my Grandma’s story. Obviously hers is a bit extreme, being 87 and having had it twice and had complications.

She’s doing fine now though. :slight_smile:

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Ok, I just read another post, seems it goes into the lungs?? Anyway the doc was really concerned about it moving and killing her so he put a filter in really quickly.