Blood Clot

Blood Clot
Hi Jonni,
My husband also had an embolism but it was in his carotid artery and unfortunately was not visible. You are very fortunate that they are treating it in time. My husband required 10 hours of surgery to repair it once it ruptured and had a stroke during surgery. I honestly don't know how the doctors can say they don't know what caused it. Our doctors were very clear that radiation had damaged the arterial walls. This happened about 4 months post treatment.
I am very happy to see that they caught it in time for your husband. I don't know much about blood thinners but do mention the side effects to your doctors. Hope all goes well.

Wendy

Our doctor said chemo caused it
Doug had bilateral pulmonary embolisms (clots in both lungs) that probably started with a clot in his leg (he noticed the leg because it hurt, but had no problems with the lungs). The chemo doc said it was one of the possible side effects of cisplatin, possibly combined with lifestyle (flying for business). He said there was a danger of clots for at least 6 months after the last chemo treatment.

However, I think your question about radiation damage is relevant - Doug had old damage in his leg, which may be why the clots started there (and why it took a week to figure it out - he thought it was just a flare-up of the damage). We're pretty sure it was not caused by inactivity - Doug was still very active and had played hockey the night before they put him in the hospital for the clots.

About treatment - the two main options are warfarin (coumadin) which inhibits production of the clotting factor in your blood, and lovenox (low molecular weight heparin) which accelerates decomposition of the clotting factors. Coumadin is a pill, and it takes a few days to get up to working levels, so they often give lovenox for the first few days. They monitor effectiveness of coumadin by doing blood clotting tests - basically they want you to clot 3-5 times slower than normal. The big problem is that coumadin works by inhibiting vitamin K recycling; if your diet varies a lot in vitamin K, the effectiveness of the coumadin also goes up and down. For a chemo patient, who might not be able to eat regularly, this can be an issue (it was for us). Coumadin also takes at least 5 days to clear your system, so if you expect to have surgery, they prefer to have you switch to lovenox.

Lovenox is a daily shot, and it is not affected by your diet. It clears your system in about a day, which is why we continued it even after Doug could eat again, since he insisted on playing hockey. His doctor agreed that if he got hurt, they could keep him alive a day until the lovenox wore off (I also sent him with blood-clot accelerating bandages and asked him to warn his teammates - don't know if that happened).

Coumadin is considered to have fewer side effects, and the daily shots of lovenox can be a literal pain, so coumadin is likely the drug of choice if your diet is regular and you aren't playing contact sports. I'd suggest talking to your doctor about how long he should take the anti-clotting drugs - again, our chemo doctor wanted to treat for 6 months after the last chemo treatment, but your doctor might have a different protocol.

BTW, with both drugs, you should avoid aspirin, motrin and naproxen sodium, as they further inhibit clotting. Let the doctor know if you have symptoms of internal bleeding, like stomach pain, or dark stools.