Avastin withheld due to blood thinners

Chelsea71
Chelsea71 Member Posts: 1,169
My husband, Steve's, blood clots continue to be an issue. Went to chemo on Wed. Saw onc before chemo. Face and neck still really really really swollen. Voice has not sounded normal. I think the onc was concerned. I asked her if she could prescribe a steroid to reduce the inflammation. She presc. dexamethasone 4 mg. Half tab B.I.D. (4 mg daily). Worked like a charm. Face looks almost normal. Voice normal too. One of the clots is near the portocath. There is concern about whether the clot is hard or soft. If hard, great. But if soft, it may be absorbing the chemo and therefore the chemo will be less effective. He goes for a portogram on Wed. This will determine if it's soft or hard. If soft, they will not use the port for chemo. He will get it through a vein and have to stay in the hospital for the entire 3 days. (until disconnection time). Hopefully it's hard. I think over time the blood thinner will cause it to become hard and then hopefully dissolve. I really don't know. Meanwhile the onc has stopped the Avastin. She is nervous about him getting it while on blood thinners. She will bring this up at an up-coming meeting and get others opinions. Until then, no Avastin. Is anyone on blood thinners and Avastin? It seems to be this oncologists nature to be very cautious. I wonder if it's necessary to withold the Avastin? Any thoughts?

Chelsea
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Comments

  • herdizziness
    herdizziness Member Posts: 3,624
    Off Avastin during blood thinners

    When I had my heart attack and went on blood thinners I had to quit Avastin the complete time I was on the blood thinners.  

    Here's hoping the blood clot dissolves quickly.

    Winter Marie

  • Chelsea71
    Chelsea71 Member Posts: 1,169

    Off Avastin during blood thinners

    When I had my heart attack and went on blood thinners I had to quit Avastin the complete time I was on the blood thinners.  

    Here's hoping the blood clot dissolves quickly.

    Winter Marie

    ****! Steve will be on blood
    ****! Steve will be on blood thinners for the rest of his life. Thanks for the response, Winter Marie. What kind if blood thinner did you take and was it oral or an injection?

    Sandy - if you're following this. I remember you saying that your daughter was on lovenox. Could she take Avastin with her chemo?

    Thanks
    Chelsea
  • herdizziness
    herdizziness Member Posts: 3,624
    Chelsea71 said:

    ****! Steve will be on blood
    ****! Steve will be on blood thinners for the rest of his life. Thanks for the response, Winter Marie. What kind if blood thinner did you take and was it oral or an injection?

    Sandy - if you're following this. I remember you saying that your daughter was on lovenox. Could she take Avastin with her chemo?

    Thanks
    Chelsea

    Chelsea

    It was oral, called Plavix or Clopidogrel 75 mg.

    Winter Marie

  • Sundanceh
    Sundanceh Member Posts: 4,392 Member
    "The Doctor Is In?"

    Wow Chels!

    The onc couldn't figure out on her own to try a steroid?

    That's what always amaze is how WE the patient have to doctor ourselves when "the experience" around us - fail us.

    Good call!!  And so glad that the swelling is down...swelling bad enough  to choke his voice off...could have led to breathing if left unattended.

    You probably saved his life...

    I believe I would want you on my team:)  You're GOOD!

    Tell hubby I said so, LOL!

    W2Go!

    -Craig

     

  • Chelsea71
    Chelsea71 Member Posts: 1,169
    Sundanceh said:

    "The Doctor Is In?"

    Wow Chels!

    The onc couldn't figure out on her own to try a steroid?

    That's what always amaze is how WE the patient have to doctor ourselves when "the experience" around us - fail us.

    Good call!!  And so glad that the swelling is down...swelling bad enough  to choke his voice off...could have led to breathing if left unattended.

    You probably saved his life...

    I believe I would want you on my team:)  You're GOOD!

    Tell hubby I said so, LOL!

    W2Go!

    -Craig

     

    Hi Craig,
    I'm really

    Hi Craig,

    I'm really astounded by the mistakes that have been made over the course of the past two weeks with regards to these blood clots. I think there have been "so many mitts in the pot," that the "right hand doesn't know what the left hand is doing". Neither the thrombosis doc or the onc thought of the possible complications of the clot near the portocath. Took a chemo nurse to recognize there might be a problem. As far as the steroids, I didn't just mention them, I had to convince her to try them. Had we stayed quiet, we would have left that app. with nothing and his head would still be as big as a watermelon. You really can't just sit back, go for the ride and assume your doctors know what their doing. Thank God for the medical websites and all you guys here. Sadly, this seems to be our most reliable source of info.

    All for now,
    Dr. Chelsea
  • janie1
    janie1 Member Posts: 753
    Chelsea71 said:

    Hi Craig,
    I'm really

    Hi Craig,

    I'm really astounded by the mistakes that have been made over the course of the past two weeks with regards to these blood clots. I think there have been "so many mitts in the pot," that the "right hand doesn't know what the left hand is doing". Neither the thrombosis doc or the onc thought of the possible complications of the clot near the portocath. Took a chemo nurse to recognize there might be a problem. As far as the steroids, I didn't just mention them, I had to convince her to try them. Had we stayed quiet, we would have left that app. with nothing and his head would still be as big as a watermelon. You really can't just sit back, go for the ride and assume your doctors know what their doing. Thank God for the medical websites and all you guys here. Sadly, this seems to be our most reliable source of info.

    All for now,
    Dr. Chelsea

    double

    double

  • janie1
    janie1 Member Posts: 753
    Chelsea71 said:

    Hi Craig,
    I'm really

    Hi Craig,

    I'm really astounded by the mistakes that have been made over the course of the past two weeks with regards to these blood clots. I think there have been "so many mitts in the pot," that the "right hand doesn't know what the left hand is doing". Neither the thrombosis doc or the onc thought of the possible complications of the clot near the portocath. Took a chemo nurse to recognize there might be a problem. As far as the steroids, I didn't just mention them, I had to convince her to try them. Had we stayed quiet, we would have left that app. with nothing and his head would still be as big as a watermelon. You really can't just sit back, go for the ride and assume your doctors know what their doing. Thank God for the medical websites and all you guys here. Sadly, this seems to be our most reliable source of info.

    All for now,
    Dr. Chelsea

    Good GRIEF....Chelsea.  You

    Good GRIEF....Chelsea.  You had to convince the doctor to try steroids???!#!!  That's just plain wrong....scary.  You deserve the doctor credentials......way to go and being assertive.  Sigh...

    And, i can't believe the doctor initially had the frightened look on her face when she saw Steve.  Couldn't she at least faked it and remained expression-less until she composed herself?

    The last thing a patient needs is to see that look of horror on the doctors face.....for crying out loud.

    My best to you.....and to better days.

  • Chelsea71
    Chelsea71 Member Posts: 1,169
    janie1 said:

    Good GRIEF....Chelsea.  You

    Good GRIEF....Chelsea.  You had to convince the doctor to try steroids???!#!!  That's just plain wrong....scary.  You deserve the doctor credentials......way to go and being assertive.  Sigh...

    And, i can't believe the doctor initially had the frightened look on her face when she saw Steve.  Couldn't she at least faked it and remained expression-less until she composed herself?

    The last thing a patient needs is to see that look of horror on the doctors face.....for crying out loud.

    My best to you.....and to better days.

    Yeah, it is kind of scary.
    Yeah, it is kind of scary. She seemed concerned about the nausea that the steroids may cause. Nausea has never been an issue for Steve. With all the Folfiri, he has not experienced 30 seconds of nausea or any gastrointestinal discomfort. I pointed out to her that something had to be tried. Nausea would be a small price to pay to reduce the swelling and other symptoms. Plus, aren't the clot symptoms more serious than possible nausea? She prescribed pantoprazole as a P.R.N. He hasn't had to use it.

    Even the thrombosis doc who is used to seeing svco (superior vena cava obstruction) symptoms, was surprised by Steve's appearance. Told Steve that he was the "talk of the hospital". (and it's quite a large hospital). Steve actually got quite a kick out of that. I must admit though, it really was quite something. Very big face and neck. Very blue/purple skin. All kinds of blue veins popping out of his chest and even some on his back. They were trying to compensate for the vena cava vein that was blocked. I really hope those blood thinners are doing their job and the symptoms don't come back. There is enough to deal with with the actual cancer. Additional problems, we do not need!

    Take care,
    Chelsea
  • LivinginNH
    LivinginNH Member Posts: 1,456
    Chelsea71 said:

    Yeah, it is kind of scary.
    Yeah, it is kind of scary. She seemed concerned about the nausea that the steroids may cause. Nausea has never been an issue for Steve. With all the Folfiri, he has not experienced 30 seconds of nausea or any gastrointestinal discomfort. I pointed out to her that something had to be tried. Nausea would be a small price to pay to reduce the swelling and other symptoms. Plus, aren't the clot symptoms more serious than possible nausea? She prescribed pantoprazole as a P.R.N. He hasn't had to use it.

    Even the thrombosis doc who is used to seeing svco (superior vena cava obstruction) symptoms, was surprised by Steve's appearance. Told Steve that he was the "talk of the hospital". (and it's quite a large hospital). Steve actually got quite a kick out of that. I must admit though, it really was quite something. Very big face and neck. Very blue/purple skin. All kinds of blue veins popping out of his chest and even some on his back. They were trying to compensate for the vena cava vein that was blocked. I really hope those blood thinners are doing their job and the symptoms don't come back. There is enough to deal with with the actual cancer. Additional problems, we do not need!

    Take care,
    Chelsea

    Dang!! That description of

    Dang!! That description of his appearance was much worse than I had previously imagined.  I'm glad that you've discovered early on that the doctors can often be clueless.   And Craig's right - you probably saved his life!

    All my best,

    Cynthia

  • herdizziness
    herdizziness Member Posts: 3,624
    Chelsea71 said:

    Yeah, it is kind of scary.
    Yeah, it is kind of scary. She seemed concerned about the nausea that the steroids may cause. Nausea has never been an issue for Steve. With all the Folfiri, he has not experienced 30 seconds of nausea or any gastrointestinal discomfort. I pointed out to her that something had to be tried. Nausea would be a small price to pay to reduce the swelling and other symptoms. Plus, aren't the clot symptoms more serious than possible nausea? She prescribed pantoprazole as a P.R.N. He hasn't had to use it.

    Even the thrombosis doc who is used to seeing svco (superior vena cava obstruction) symptoms, was surprised by Steve's appearance. Told Steve that he was the "talk of the hospital". (and it's quite a large hospital). Steve actually got quite a kick out of that. I must admit though, it really was quite something. Very big face and neck. Very blue/purple skin. All kinds of blue veins popping out of his chest and even some on his back. They were trying to compensate for the vena cava vein that was blocked. I really hope those blood thinners are doing their job and the symptoms don't come back. There is enough to deal with with the actual cancer. Additional problems, we do not need!

    Take care,
    Chelsea

    Great Job

    Watching out for your hubby!  

    Winter Marie

  • smokeyjoe
    smokeyjoe Member Posts: 1,425
    janie1 said:

    double

    double

    I've been on lovenox for two

    I've been on lovenox for two years now, shots every day....oncologist said I'd be on lovenox for the rest of my life.... my oncologist was VERY hesitant to try avastin on me.    I haven't had any blood clot issues in two years though,  maybe that's why we're trying the avastin.    

  • Chelsea71
    Chelsea71 Member Posts: 1,169
    smokeyjoe said:

    I've been on lovenox for two

    I've been on lovenox for two years now, shots every day....oncologist said I'd be on lovenox for the rest of my life.... my oncologist was VERY hesitant to try avastin on me.    I haven't had any blood clot issues in two years though,  maybe that's why we're trying the avastin.    

    Good luck with the avastin.
    Good luck with the avastin. What confuses me is last year Steve had a blood clot and went on blood thinners for six months. Throughout that time he was also on Folfiri and avastin. I don't understand what is different this time. Is it because there are numerous clots? I pointed this all out to the oncologist and asked what is different this time around. She didn't answer me, just said that she had to look into it.
  • herdizziness
    herdizziness Member Posts: 3,624
    Chelsea71 said:

    Good luck with the avastin.
    Good luck with the avastin. What confuses me is last year Steve had a blood clot and went on blood thinners for six months. Throughout that time he was also on Folfiri and avastin. I don't understand what is different this time. Is it because there are numerous clots? I pointed this all out to the oncologist and asked what is different this time around. She didn't answer me, just said that she had to look into it.

    I didn't

    Have any clots just the stent inserted in artery and they still wouldn't let me on Avastin.

    criteria must be different for everyone I'm guessing.

  • coloCan
    coloCan Member Posts: 1,944 Member

    I didn't

    Have any clots just the stent inserted in artery and they still wouldn't let me on Avastin.

    criteria must be different for everyone I'm guessing.

    If a port can't be used,have you thought of using a PICC,

    which might be easier on your husband than infusiion directly into vein?

  • Mustangmania
    Mustangmania Member Posts: 1
    Avastin and blood clots

    Hi my husband has a history of blood clots and he got one in his leg during his chemo treatment he had only one treatment and then his legs and feet started swelling.  He was not eating or drinking much fluid and became dehydrated.  We had a follow up with the surgeon who had done his colonoscopy and they were concerned with how weak he was and that he was dehydrated.  I told them I wish they could just put him in the hospital and get some fluids in him and the surgeon made some calls and got him admitted right away.  He even walked him over to the hospital from his office in a wheel chair.  While in the hospital they did an ultrasound of his leg and found the blood clot.  He was previously on warfrin (pill) but they have now put him on Lovenox by injection everyday.  He is still receiving Avastin along with other chemo drugs.  His swelling has gone down.

  • Chelsea71
    Chelsea71 Member Posts: 1,169
    coloCan said:

    If a port can't be used,have you thought of using a PICC,

    which might be easier on your husband than infusiion directly into vein?

    Because one of the clots is
    Because one of the clots is near the port, there is some concern that the clot may be absorbing some of the chemo and therefore preventing it from getting to where it needs to go. He goes for a portogram tomorrow. This will determine if the clot is soft or hard. If hard - great. This means it is not absorbing the chemo. Nothing will change. However, if soft, this means it is absorbing the chemo. If this turns out to be the case, then they will not use the portocath for his chemo infusions. Steve asked if a picc line would be started. The answer was no. (Steve did not ask why not!). She explained that he would get the chemo directly into his vein and would have to remain in the hospital for the entire three days! So, it seems like a picc line will not be happening but not sure as to why. Got the impression that it would be too dangerous because of the clots. But not sure. Will find out tomorrow. This whole clot saga seems never-ending. You guys must be so sick of me going on and on about these damn clots.

    Chelsea
  • Chelsea71
    Chelsea71 Member Posts: 1,169

    Avastin and blood clots

    Hi my husband has a history of blood clots and he got one in his leg during his chemo treatment he had only one treatment and then his legs and feet started swelling.  He was not eating or drinking much fluid and became dehydrated.  We had a follow up with the surgeon who had done his colonoscopy and they were concerned with how weak he was and that he was dehydrated.  I told them I wish they could just put him in the hospital and get some fluids in him and the surgeon made some calls and got him admitted right away.  He even walked him over to the hospital from his office in a wheel chair.  While in the hospital they did an ultrasound of his leg and found the blood clot.  He was previously on warfrin (pill) but they have now put him on Lovenox by injection everyday.  He is still receiving Avastin along with other chemo drugs.  His swelling has gone down.

    How interesting! This must
    How interesting! This must be something that varies depending on the individual situation. You may want to ask the onc about the avastin. I've heard from very reliable sources that this can be quite risky. Sorry that you and your husband are dealing with all this. Is he tolerating the chemo well? How are you holding up?

    Chelsea
  • Momof2plusteentwins
    Momof2plusteentwins Member Posts: 509 Member
    Chelsea71 said:

    Because one of the clots is
    Because one of the clots is near the port, there is some concern that the clot may be absorbing some of the chemo and therefore preventing it from getting to where it needs to go. He goes for a portogram tomorrow. This will determine if the clot is soft or hard. If hard - great. This means it is not absorbing the chemo. Nothing will change. However, if soft, this means it is absorbing the chemo. If this turns out to be the case, then they will not use the portocath for his chemo infusions. Steve asked if a picc line would be started. The answer was no. (Steve did not ask why not!). She explained that he would get the chemo directly into his vein and would have to remain in the hospital for the entire three days! So, it seems like a picc line will not be happening but not sure as to why. Got the impression that it would be too dangerous because of the clots. But not sure. Will find out tomorrow. This whole clot saga seems never-ending. You guys must be so sick of me going on and on about these damn clots.

    Chelsea

    Chelsea
    I got my clot from a picc line. They probably think it is too risky for him to get one. I am still taking lovenox shots everyday - clot is still there - not as big - right upper arm - where picc was.
    Good luck
    Sandy :)
  • Lovekitties
    Lovekitties Member Posts: 3,364 Member

    Avastin and blood clots

    Hi my husband has a history of blood clots and he got one in his leg during his chemo treatment he had only one treatment and then his legs and feet started swelling.  He was not eating or drinking much fluid and became dehydrated.  We had a follow up with the surgeon who had done his colonoscopy and they were concerned with how weak he was and that he was dehydrated.  I told them I wish they could just put him in the hospital and get some fluids in him and the surgeon made some calls and got him admitted right away.  He even walked him over to the hospital from his office in a wheel chair.  While in the hospital they did an ultrasound of his leg and found the blood clot.  He was previously on warfrin (pill) but they have now put him on Lovenox by injection everyday.  He is still receiving Avastin along with other chemo drugs.  His swelling has gone down.

    Avastin

    Avastin's roll in the formation of blood clots is known.

    Here is info I pulled from the FDA site which lists approved meds and also shows approved labeling:

     

     On  the label  insert 11/20/2012 section 5.5 (not sure when this exactly was put on label)

     

     

    Arterial Thromboembolic Events 154 Serious, sometimes fatal, arterial thromboembolic events (ATE) including cerebral infarction, 155 transient ischemic attacks, myocardial infarction, angina, and a variety of other ATE occurred at a 156 higher incidence in patients receiving Avastin compared to those in the control arm. Across 157 indications, the incidence of Grade  3 ATE in the Avastin containing arms was 2.6% compared to 158 0.8% in the control arms. Among patients receiving Avastin in combination with chemotherapy, the 159 risk of developing ATE during therapy was increased in patients with a history of arterial 160 thromboembolism, or age greater than 65 years. [See Use in Specific Populations (8.5).] 161 The safety of resumption of Avastin therapy after resolution of an ATE has not been studied. 162 Discontinue Avastin in patients who experience a severe ATE. [See Dosage and Administration

    See the following for full insert info: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125085s265lbl.pdf

  • Chelsea71
    Chelsea71 Member Posts: 1,169

    Avastin

    Avastin's roll in the formation of blood clots is known.

    Here is info I pulled from the FDA site which lists approved meds and also shows approved labeling:

     

     On  the label  insert 11/20/2012 section 5.5 (not sure when this exactly was put on label)

     

     

    Arterial Thromboembolic Events 154 Serious, sometimes fatal, arterial thromboembolic events (ATE) including cerebral infarction, 155 transient ischemic attacks, myocardial infarction, angina, and a variety of other ATE occurred at a 156 higher incidence in patients receiving Avastin compared to those in the control arm. Across 157 indications, the incidence of Grade  3 ATE in the Avastin containing arms was 2.6% compared to 158 0.8% in the control arms. Among patients receiving Avastin in combination with chemotherapy, the 159 risk of developing ATE during therapy was increased in patients with a history of arterial 160 thromboembolism, or age greater than 65 years. [See Use in Specific Populations (8.5).] 161 The safety of resumption of Avastin therapy after resolution of an ATE has not been studied. 162 Discontinue Avastin in patients who experience a severe ATE. [See Dosage and Administration

    See the following for full insert info: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125085s265lbl.pdf

    Thank you, Marie.
    Chelsea

    Thank you, Marie.

    Chelsea