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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is Fraxiparine Sc Therapy Suggestible For Varicose Veins In Both Legs?

Dear Doctor, I would appreciate your opinion a lot !! My mom is 72 years old. She has got for a while varicose veins in both legs around area of the knee. Last month she developed superficial thrombophlebitis of her right leg which is now resolved. The great saphenous vein was also affected, precisely 1/3 of this vein was affected in the upper area of the lower leg and lower area of the thigh. 1. She went under Fraxiparine sc therapy 2x per day for 10 days. I saw online that sometimes this therapy could be prolonged up to 1 month. Could you please tell me in which cases is that, is it in the case when the great saphenous vein is affected as well ? Her current therapy is Detralex tabl. (Daflon) 2x1, Lioton cream 100.000 IU/ 100g, Aspirin 100 mg 1x1 and compressive/supportive thights. 2. Please let me know your opinion about this therapy. What is the best dosage for Aspirin ? 3. Are there are any other medication or supplements that we can add and what would be the best dosage. ( krill oil, vit. E, statins, what about Plavix (Clopidogrel) instead of Aspirin her Plt are 150x10*9 on the scale 150-400x10*9) ? 4. Is it true that krill oil can be use instead of statins ? 5. What diagnostic procedures should be best to run in her case? 6. Also, I found out, that she should make a short walks often. Please let me know how often they should be and for how long? And for longs walks in the park, is it any time limitation? 7. Is it right that blood clot can be dissolved naturally by time? 8. My most important question is your opinion regarding surgery. Should we go for it? And if yes, what would be better for her, to go for classic surgery treatment or laser and why? 9.Should it be done ASAP or is it any time that we need to wait for surgery or laser or any other treatment as she had thrombophlebitis ? In case that laser is choice, can it be applied on the great saphenous vein ? Is it any risk that blood clot can migrate to another vein during laser treatment ? Sorry for asking all this, but its only cos I would like to do what is best for my mom. Thank you so much for helping me in this matter, its appreciated a lot !! My very best, Mila.
Mon, 14 Aug 2017
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  User's Response
To answer your questions -
1 Usually this therapy is for deep vein thrombosis (femoral, popliteal, iliac, inferior vena cava). The saphenous vein is not considered a deep vein, which is why she was not placed on it for a longer period of time.
2. The usual dose of aspirin is 81mg daily. This is a standard dose usually used by both cardiologists and vascular surgeons.
3. Plavix can be used, however this is usually reserved for patients who have had cardiac or vascular stents placed, or patients with severe vascular disease. This will increase bleeding risk. Of note, plavix and aspirin do not affect the number of platelets that one has, they affect the function of platelets. The best test to see the effect aspirin or plavix has is either bleeding time or platelet function assays.
4. Statins have been well studied and have beneficial effects. There is no evidence shown that Krill Oil is equivalent or superior to statins. If your mother does not have any contraindications to statins (liver disease for example), then I would recommend she continue with the statins, as they have also been shown to have cardiac protective effects in multiple studies.
5. She should continue to have ultrasounds of her bilateral lower extremities.
6. She should walk as much as possible! There is no limitation. Walking is great treatment for varicose veins as well as her overall health.
7. Blood clots will usually not dissolve, they will scar and become part of the vessel. However, your body will tend to use collaterals (think of it as taking side streets when the main road is blocked).
8. Laser ablation can be an effective treatment for varicose veins, however your mother should have a patent deep vein system in order for this to be effective. Make sure she has a recent ultrasound of her leg in order to asses this.
9. There is no hurry here. Varicose veins are usually treated for symptoms, not to prevent other clots forming. Clots in varicose veins will not lead to deep venous thrombosis. There is no risk of the clot migrating to another vein during the treatment

In summary, I would have your mom continue her aspirin and her statin, get her to walk and wear her compression stockings as much as possible. If she is a candidate for laser ablation, it may help her symptoms with her varicose veins. There is no risk of clots in these veins going to her lungs, and we usually do not put people on long term anticoagulation for this.

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Is Fraxiparine Sc Therapy Suggestible For Varicose Veins In Both Legs?

To answer your questions - 1 Usually this therapy is for deep vein thrombosis (femoral, popliteal, iliac, inferior vena cava). The saphenous vein is not considered a deep vein, which is why she was not placed on it for a longer period of time. 2. The usual dose of aspirin is 81mg daily. This is a standard dose usually used by both cardiologists and vascular surgeons. 3. Plavix can be used, however this is usually reserved for patients who have had cardiac or vascular stents placed, or patients with severe vascular disease. This will increase bleeding risk. Of note, plavix and aspirin do not affect the number of platelets that one has, they affect the function of platelets. The best test to see the effect aspirin or plavix has is either bleeding time or platelet function assays. 4. Statins have been well studied and have beneficial effects. There is no evidence shown that Krill Oil is equivalent or superior to statins. If your mother does not have any contraindications to statins (liver disease for example), then I would recommend she continue with the statins, as they have also been shown to have cardiac protective effects in multiple studies. 5. She should continue to have ultrasounds of her bilateral lower extremities. 6. She should walk as much as possible! There is no limitation. Walking is great treatment for varicose veins as well as her overall health. 7. Blood clots will usually not dissolve, they will scar and become part of the vessel. However, your body will tend to use collaterals (think of it as taking side streets when the main road is blocked). 8. Laser ablation can be an effective treatment for varicose veins, however your mother should have a patent deep vein system in order for this to be effective. Make sure she has a recent ultrasound of her leg in order to asses this. 9. There is no hurry here. Varicose veins are usually treated for symptoms, not to prevent other clots forming. Clots in varicose veins will not lead to deep venous thrombosis. There is no risk of the clot migrating to another vein during the treatment In summary, I would have your mom continue her aspirin and her statin, get her to walk and wear her compression stockings as much as possible. If she is a candidate for laser ablation, it may help her symptoms with her varicose veins. There is no risk of clots in these veins going to her lungs, and we usually do not put people on long term anticoagulation for this. I hope this is helpful!