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What Does This Blood Test Report Regarding DVT Indicate?
Question: currently being treated for 2nd episode of DVT(warfarin failure with therapeutic range of 2.7). First occurance 1 year ago blood tests at that time showed: RDW-High, D-Dimer-High, Macrocytosis-slight, Anisocytosis, platelet morphology w/ large forms, metamyelocytes-High, and myelocytes-High..what could be the possible reasons for those lab results and could any of the reasons contribute to having another occlusive DVT while on warfarin in therapeutic range... hematologist is going to be doing some genetic testing, seeking why a clotting disorder thank you
Brief Answer:
Considerations
Detailed Answer:
thanks for sending the question.
I agree thatadditional laboratory testing needs to be done including genetic tests for inherited disorders which can predispose to blood clotting. Your doctor will also request analysis looking for Cardiolipin antibodies and lupus anticoagulant which are circulating proteins which can increase the risk for blood clots.
I wonder if your Coumadin level has fluctuated even though it remains in a normal range when you get it tested. By this I mean I wonder if it somehow fluctuates below the level of two on certain occasions.if you did develop a blood clot despite having therapeutic Coumadin level you might be a candidate for alternative anticoagulation.there are several new anticoagulants which have been approved by the FDA in the United States. These medications have been used also in other countries successfully.
I think it will take some time for the blood tests to return results in order to help guide your primary care physician in making decisions regarding appropriate continued anticoagulation.
thank you again for sending your question. Please let us know if you have additional specific concerns.
Sincerely,
Dr. Galamaga
Considerations
Detailed Answer:
thanks for sending the question.
I agree thatadditional laboratory testing needs to be done including genetic tests for inherited disorders which can predispose to blood clotting. Your doctor will also request analysis looking for Cardiolipin antibodies and lupus anticoagulant which are circulating proteins which can increase the risk for blood clots.
I wonder if your Coumadin level has fluctuated even though it remains in a normal range when you get it tested. By this I mean I wonder if it somehow fluctuates below the level of two on certain occasions.if you did develop a blood clot despite having therapeutic Coumadin level you might be a candidate for alternative anticoagulation.there are several new anticoagulants which have been approved by the FDA in the United States. These medications have been used also in other countries successfully.
I think it will take some time for the blood tests to return results in order to help guide your primary care physician in making decisions regarding appropriate continued anticoagulation.
thank you again for sending your question. Please let us know if you have additional specific concerns.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you for your reply. I am trying to educate myself on the possible outcomes gives the labs and the DVT's. I want to make sure I ask all needed questions to my hematologist while I am here in the hospital.
I have my own pt/inr meter which I test myself-results get reported to cardiovascular-than the Coumadin clinic in his office guides me. Oddly, my pt/inr had been very hard to keep in the therapeutic range-Oddly because it tended to be high. In the year on warfarin it did go to 1.4-1.8 maybe twice. I did test weekly.
Current plan since I am in hospital at the moment-once Im off the heparin drip, I will be sent home with lovenox than after approx. 2 months switch to xarelto. 3 of the specialists involved in my care this hospital visit are discussing an IVC filter.
I have my own pt/inr meter which I test myself-results get reported to cardiovascular-than the Coumadin clinic in his office guides me. Oddly, my pt/inr had been very hard to keep in the therapeutic range-Oddly because it tended to be high. In the year on warfarin it did go to 1.4-1.8 maybe twice. I did test weekly.
Current plan since I am in hospital at the moment-once Im off the heparin drip, I will be sent home with lovenox than after approx. 2 months switch to xarelto. 3 of the specialists involved in my care this hospital visit are discussing an IVC filter.
Brief Answer:
Follow up
Detailed Answer:
thanks for the additional information.
I am curious to know why the doctors are recommending that you maintain Lovenox for two months prior to switching to Xarelto. I assume there is some type of logic behind this.
The filter discussion is generally entertained in the setting of a patient who cannot obtain appropriate anticoagulation while having an active thrombosis.
I generally prefer to avoid using the filter unless absolutely indicated.
I hope you're feeling better and that you are getting closer to discharge. Please let me know when you additional information you have obtained in the last couple of days.
Dr. Galamaga
Follow up
Detailed Answer:
thanks for the additional information.
I am curious to know why the doctors are recommending that you maintain Lovenox for two months prior to switching to Xarelto. I assume there is some type of logic behind this.
The filter discussion is generally entertained in the setting of a patient who cannot obtain appropriate anticoagulation while having an active thrombosis.
I generally prefer to avoid using the filter unless absolutely indicated.
I hope you're feeling better and that you are getting closer to discharge. Please let me know when you additional information you have obtained in the last couple of days.
Dr. Galamaga
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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