General Question

Riparian's avatar

Superficial blood clot, and taking anticoagulants, surgery or not?

Asked by Riparian (13points) October 9th, 2008

My wife has a blood clot in her superficial femoral vein that extends into her iliac veins. Two surgeons have said that thrombosis (catheter lacing) is not necessary since her pain and swelling are way down. Should we still be thinking of proceeding with the lycing? Or should we go with the surgeons and take the anticoagulant route?

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9 Answers

Nimis's avatar

If you want a third opinion, I’d say ask a third surgeon?

Riparian's avatar

The second opinion was my step brother who is in the same field as the local surgeon, I guess I was more looking for a “has anyone else taken the anticoagulant route as opposed to surgery” response. Thank you though.

Nimis's avatar

Whatever he’s about to say.
[points at Shilolo]

shilolo's avatar

Sadly, there is no consensus on the appropriate treatment of superficial venous thrombosis (clots). Catheter based lysis can be done, but I would tend to agree that if she is already better using conservative measures, I would favor continuing those measures, including a short course of anticoagulation.

Nimis's avatar

What are the pros to going the lysis route?
I’m curious if there is a reason for not going the more conservative route?
Your word choice (proceed) seems to indicate that you were originally going with that?

Riparian's avatar

According to what we’ve been told the lysis goes up and actively breaks up the clot, and the risk of pulmonary embolism (i.e. piece of the clot breaking of and moving into the lungs, brain or heart) is lower since the clot would be more or less removed by the catheter device. however they also both said that the chances of a embolism were also much lower since they put her on Coumadin & Lovenox. So it’s a kind of win win, but with the lysis the clot is physically removed, and with just the blood thinners the clot dissolves back into the body. Both results are the same just one is less invasive. My biggest concern is a pulmonary embolism even on the Blood thinners.

shilolo's avatar

The risk of pulmonary embolism from superficial clots is quite low. Adding the benefit of blood thinners (though, she needs to transition from lovenox to coumadin) reduces the risk even more so. That said, there is no such thing as zero risk. There is no data supporting the use of clot lysis, neither for superficial nor deeper clots. In fact, for deep venous thrombosis (DVT), clot lysis is not the standard of care.

Nimis's avatar

I’d imagine that your surgeon has already carefully weighed the (apparently low?) risk for pulmonary embolism with the various risks of an invasive surgery.

Even still, I’d be tempted to ask for a second and third opinion. Not from other patients,
but from other surgeons that have a better grasp of your wife’s medical history.
There seems to be a mind-boggling myriad of things to consider.

Starburst's avatar

only a doctor who has taken a thorough history and physical and done a complete examination can even speculate as to what your options are.

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