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What Is The Treatment For Chronic DVT?
Question: What is the treatment for chronic DVT (Deep Vein Thrombosis)> My daughter is suffering
from it and she has received many treatments but it is not working. What is the alternative?
XXXXXX
from it and she has received many treatments but it is not working. What is the alternative?
XXXXXX
Brief Answer:
Try Fondaparinux.
Detailed Answer:
Hello Mr XXXXXXX Thank you for the question and detailed history and investigation plus INR chart. I commend you for going through and bearing a lot of pain and struggle. Reading all the reactions and responses to medicines I would suggest (Specialising in Vascular Surgery) that you try Inj Fondaparinux or Arixtra. It has low bleeding complications and once daily dose and is now used worldwide for both DVT and PE. You can discuss with your Doctor and start her on that and dont give Acitrom or Warfarin. Continue Fondaparinux for six months and if she is symptom free then we can reassess the situation. Please do let me know if there are other queries I can attempt to resolve.
Take care.
Dr Rishi, New XXXXXXX XXXXXXX
Try Fondaparinux.
Detailed Answer:
Hello Mr XXXXXXX Thank you for the question and detailed history and investigation plus INR chart. I commend you for going through and bearing a lot of pain and struggle. Reading all the reactions and responses to medicines I would suggest (Specialising in Vascular Surgery) that you try Inj Fondaparinux or Arixtra. It has low bleeding complications and once daily dose and is now used worldwide for both DVT and PE. You can discuss with your Doctor and start her on that and dont give Acitrom or Warfarin. Continue Fondaparinux for six months and if she is symptom free then we can reassess the situation. Please do let me know if there are other queries I can attempt to resolve.
Take care.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you for your response. We have received a SECOND opinion from an Internal Medicine Specialist mentioning that she should take WARFARIN contrary to your advice. Please comment as we are confused.
"I have read your question and understand your concerns.
Unfortunate that she has suffered from such problems from longtimes.
Deep venous thrombosis patients have always more chances of pulmonary embolism. So Longterm anticoagulation with warfarin or heparin is recommended.
Actually thrombophillia work up should be done after 3 weeks stoppage of warfarin otherwise reports can be modified. So kindly confirm about that thing.
Warfarin is still has better efficacy then some of the newer anticoagulants in prevention of pulmonary embolism in dvt patients. But the problem is that the protein C and protein S are also get affected by warfarin treatment. So in patients with protein C and S deficiency and resistance, warfarin treatment has controversial role.
Second thing to remember is all green leafy vegetables including spinach, carrot, cabbage should be avoided during warfarin treatment. Otherwise it will not be effective .
At present my advice is continue LMWH and confirm that reports are reliable or not. If reports are reliable then warfarin treatment has controversial role and better to continue with LMWH.
Ask your doctor about IVC filters, which can prevent pulmonary embolism in chronic DVT patients. Avoid prolonged air travel, avoid prolonged bed rest, prolonged standing.
Repeat lower limb venous doppler every 3 monthly.
In patients of protein C and S resistance or deficiency lifelong anticoagulation is recommended otherwise she will again have such problems. So kindly confirm about reliability of that reports, ask your doctor about IVC filters and follow my advice."
"I have read your question and understand your concerns.
Unfortunate that she has suffered from such problems from longtimes.
Deep venous thrombosis patients have always more chances of pulmonary embolism. So Longterm anticoagulation with warfarin or heparin is recommended.
Actually thrombophillia work up should be done after 3 weeks stoppage of warfarin otherwise reports can be modified. So kindly confirm about that thing.
Warfarin is still has better efficacy then some of the newer anticoagulants in prevention of pulmonary embolism in dvt patients. But the problem is that the protein C and protein S are also get affected by warfarin treatment. So in patients with protein C and S deficiency and resistance, warfarin treatment has controversial role.
Second thing to remember is all green leafy vegetables including spinach, carrot, cabbage should be avoided during warfarin treatment. Otherwise it will not be effective .
At present my advice is continue LMWH and confirm that reports are reliable or not. If reports are reliable then warfarin treatment has controversial role and better to continue with LMWH.
Ask your doctor about IVC filters, which can prevent pulmonary embolism in chronic DVT patients. Avoid prolonged air travel, avoid prolonged bed rest, prolonged standing.
Repeat lower limb venous doppler every 3 monthly.
In patients of protein C and S resistance or deficiency lifelong anticoagulation is recommended otherwise she will again have such problems. So kindly confirm about reliability of that reports, ask your doctor about IVC filters and follow my advice."
Brief Answer:
The advice is largely correct. See detailed answer
Detailed Answer:
Hello Mr XXXXXXX
I largely agree with the opinion of the Doctor.
1. The reason I suggested Fondaprinux was that it has low bleeding complications and has similar efficacy even in Protein C & S deficiencies unlike Warfarin/ Acitrom as mentioned by the Medicine Specialist.
2. The point about green vegetables is completely true and you should follow the advice.
3. It is very true that the Thrombophilia profile should be done after stopping the Acitrom/ Warfarin for 3 to 4 weeks otherwise the efficacy of the test results is in doubt.
4. IVC filter insertion in your case is also not clear as the DVT is chronic or old. But it would definitely decrease the chances of recurrent Pulmonary embolisms. As the IVC is involved in your case, the filter insertion might not be easy or straight forward and this you should discuss with the treating Surgeon or Interventionist.
5. So, I would still advice to go with Fondaparinux and keep it on for atleast three months and if the symtpoms don't recur in these months then the case can be reviewed to see whether it would be safe to switch to a different medicine.
The advice is largely correct. See detailed answer
Detailed Answer:
Hello Mr XXXXXXX
I largely agree with the opinion of the Doctor.
1. The reason I suggested Fondaprinux was that it has low bleeding complications and has similar efficacy even in Protein C & S deficiencies unlike Warfarin/ Acitrom as mentioned by the Medicine Specialist.
2. The point about green vegetables is completely true and you should follow the advice.
3. It is very true that the Thrombophilia profile should be done after stopping the Acitrom/ Warfarin for 3 to 4 weeks otherwise the efficacy of the test results is in doubt.
4. IVC filter insertion in your case is also not clear as the DVT is chronic or old. But it would definitely decrease the chances of recurrent Pulmonary embolisms. As the IVC is involved in your case, the filter insertion might not be easy or straight forward and this you should discuss with the treating Surgeon or Interventionist.
5. So, I would still advice to go with Fondaparinux and keep it on for atleast three months and if the symtpoms don't recur in these months then the case can be reviewed to see whether it would be safe to switch to a different medicine.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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