Managing Deep Vein Thrombosis: Medication Side Effects and Treatment Options

Deep vein thrombosis (DVT)

On August 10, I underwent lower limb angiography to confirm deep vein thrombosis.
The physician prescribed Warfarin in round pink tablets, with an initial dosage of 0.5 tablets.
However, due to elevated blood test results, the dosage was adjusted to 0.3 tablets, taken for two days and then stopped for one day.
I experienced side effects of urticaria and generalized itching, prompting the physician to switch me to Pradaxa.
After taking Pradaxa for five days, I encountered early menstruation with excessive bleeding.
I had previously stopped taking it for two days before my period ended, which resulted in heavy menstrual bleeding.
The physician advised me to resume the medication after my menstrual period.

Given that I have switched between two medications, both of which have caused side effects, I am concerned about how to treat the venous thrombosis if I cannot take anticoagulants.
Currently, I am experiencing swelling and pain in my lower limb, and I have a history of tibial plateau fracture with an intramedullary nail that has not yet been removed.
The orthopedic surgeon has advised me to treat the venous thrombosis first.
If surgical intervention is required to treat the thrombosis, can the nail be removed simultaneously during the procedure? Thank you.

Youwen, 30~39 year old female. Ask Date: 2017/10/03

Dr. He Dongjin reply Cardiology

Hello, You-Wen.
Regarding the orthopedic surgery for treating the embolism, it is possible to remove the steel pins during the procedure.
There are also various medications available that can be discussed with your physician for a potential change in treatment.
Changhua Hospital cares about your well-being.

Reply Date: 2017/10/03

More Info

Managing deep vein thrombosis (DVT) can be quite complex, especially when patients experience side effects from anticoagulant medications like warfarin and rivaroxaban (拜瑞妥). Your situation highlights several important considerations regarding medication management, potential side effects, and alternative treatment options.

Firstly, it’s essential to understand that anticoagulants like warfarin and rivaroxaban are prescribed to prevent the formation of new blood clots and to reduce the risk of existing clots growing larger. However, these medications can have side effects, which you have experienced. Warfarin can cause skin reactions such as urticaria (hives) and itching, while rivaroxaban can lead to bleeding complications, especially in individuals with pre-existing conditions or those taking other medications that affect coagulation.

In your case, the side effects you experienced from warfarin led to a switch to rivaroxaban, which also resulted in menstrual irregularities, including heavy bleeding. This is a known side effect of anticoagulants, particularly in women of childbearing age. It’s crucial to communicate these side effects to your healthcare provider, as they may need to adjust your treatment plan further or consider alternative therapies.

If you are unable to tolerate anticoagulants, there are other treatment options for managing DVT. Compression therapy, such as wearing graduated compression stockings, can help improve venous return and reduce symptoms. Additionally, lifestyle modifications, including regular movement and avoiding prolonged periods of immobility, are essential in preventing further clot formation.

In cases where anticoagulation is not feasible, mechanical interventions such as inferior vena cava (IVC) filters may be considered. These devices are implanted in the inferior vena cava to catch any blood clots that may travel from the legs to the lungs, thus preventing pulmonary embolism. However, IVC filters are typically reserved for patients who cannot take anticoagulants due to severe bleeding risks.

Regarding your question about surgical options, if you require surgery for DVT treatment, it is generally possible to address both the DVT and the removal of hardware (like the steel pins from your previous tibial plateau fracture) in a single surgical procedure. However, this decision should be made collaboratively between your vascular surgeon and orthopedic surgeon, considering the risks and benefits of combining the procedures.

In summary, managing DVT effectively requires a comprehensive approach that includes medication management, lifestyle changes, and possibly mechanical interventions. If anticoagulants are not tolerated, discussing alternative therapies with your healthcare provider is crucial. Regular follow-ups and monitoring are essential to ensure that your treatment plan is effective and to adjust it as necessary based on your symptoms and any side effects you may experience. Always keep an open line of communication with your healthcare team, as they can provide the best guidance tailored to your specific situation.

Similar Q&A

Understanding Vascular Blockage: Causes, Symptoms, and Treatment Options

Dear Doctor, ten months ago I developed deep vein thrombosis (DVT) in my right leg due to tight bandaging from an injury. After taking anticoagulants, a follow-up ultrasound two weeks later showed no clots. However, I later experienced pain in the back of my thigh, and the doctor...

Dr. He Dongjin reply Cardiology
Hello, based on your description, it is difficult to determine whether the issue is caused by a blood clot. If you are taking anticoagulants, it should help improve your condition. It is advisable to discuss your situation and treatment options with your attending physician. Chan...

Understanding Varicose Veins: Treatment Options and Risks Explained

Dear Dr. Ding, I recently discovered that my mother has been suffering from a long-standing issue with her legs, which seems to be varicose veins. I would like to ask you some questions regarding treatment options: 1. What are the common treatment methods available? 2. Is the t...

Dr. Ding Zhizhong reply Cardiology
Hello, Qingru: 1. There are various options available, ranging from conservative treatments (such as compression stockings, elevating the legs, and avoiding prolonged standing) to more aggressive treatments (including traditional surgery, laser therapy, radiofrequency ablation, ...

Managing Side Effects After Heart Stent Placement: A Guide for Patients

Dear Doctor, My father (55 years old) underwent the placement of a drug-eluting stent due to LAD stenosis last December. Postoperatively, the doctor prescribed DAPT (aspirin + Plavix) along with propranolol to be taken daily. However, after starting the medication, my father has...

Dr. He Dongjin reply Cardiology
Hello, if the father is not experiencing an acute myocardial infarction, he can temporarily refrain from taking INDERAL and observe whether the symptoms resolve. If the symptoms disappear, it is likely a side effect of the medication, and he should stop taking it and discuss it w...

Essential Post-Discharge Care for Pulmonary Embolism Patients

Dr. Huang: What should be taken into consideration for a patient with pulmonary embolism who is about to be discharged from the hospital? Additionally, how should family members adjust their daily routines to accommodate the patient's needs?

Dr. Huang Guosheng reply Cardiology
Hello: The treatment for pulmonary embolism, in addition to medication, also involves preventing the formation of deep vein thrombosis (DVT). The causes of deep vein thrombosis include bed rest, lack of physical activity, prolonged sitting, and coagulation disorders.