Online Health Chat with Carmel Celestin, MD

Wednesday, April 15, 2015

Description

Deep Vein Thrombosis (DVT, also called venous thrombosis) is essentially a blood clot that develops deep in the body and has the potential to break free and partially or completely block blood flow though the vein. The majority of DVTs occur in the lower leg, thigh or pelvis, although they can also occur in other areas of the body including the arm, brain, intestines, liver or kidney. Consequently, a free-traveling blood clot may greatly increase the risk of developing a life-threatening medical condition, including a pulmonary embolism, stroke or heart attack. These conditions can be very dangerous, and therefore require a prompt diagnosis with proper treatment. Therefore, it is critical for patients to become educated on the common risk factors associated with DVT as well as informed of the life-saving, preventative measures that they may apply to daily activities.

The following examples are a few of the conditions that may increase your risk of developing DVT:

  • An inherited (family) condition that increases the risk of blood clotting
  • Cancer and some of its treatments (chemotherapy)
  • Limited blood flow in a deep vein, due to injury, surgery or immobilization
  • Long periods of inactivity that decrease blood flow (sitting for an extended period of time on long trips and immobility after surgery or a serious injury)
  • Pregnancy, and the first 6 weeks after giving birth
  • Being overweight

About the Speaker

Carmel Celestin, MD, is an Associate Staff Physician in the Department of Vascular Medicine at Cleveland Clinic Florida. Her specialty interests include lower extremity edema, peripheral arterial disease, upper extremity disorders, minority and women’s health care initiatives, Raynaud’s and hypercoagulable states. Dr. Celestin received her medical degree from Howard University College of Medicine in Washington, D.C. She completed her internal medicine residency at Baystate Medical Center and a vascular medicine fellowship at Cleveland Clinic Florida.


Let’s Chat About Deep Vein Thrombosis

Welcome to our Online Health Chat "Deep Vein Thrombosis" with Carmel Celestin, MD. We are thrilled to have her here today for this chat. Let’s begin with the questions.


Deep Vein Thrombosis

LMM5: What is the difference between phlebitis and DVT?

Carmel_Celestin,_MD: Both are blood clots. Phlebitis is a term usually used to describe a clot in the superficial veins. DVT is used to describe clot in the deep veins.


Symptoms & Diagnosis

Trykkergirl: I am a 70 female with lower extremity edema most all the time. Occasionally, I’m in Afib mild-moderate mitral valve leak, mild regurgitation other heart valves. I am 230 lbs. and 5'5". Had venous insufficiency for 15 years diagnosed. I have arthritis, so I can't walk for exercise, hips/knees, but ride a recumbent tricycle on a trail 15 miles at least three or four times a week. Still have the leg swelling. I keep legs propped up every chance I can when sitting. Compression hose REALLY bother me, as I am in Florida and it’s always so hot, even during the winter. My legs hurt; my knees are down most of the time, especially behind one knee (patella-femoral pain syndrome). I always wear compression hose when flying and driving long distances. How will I know if I have DVT? What symptoms? Is it ok to use a double head massager on legs? I do so most evenings since it seems to give some relief.

Carmel_Celestin,_MD: The signs and symptoms of DVT include pain, swelling, redness of the leg. The way to confirm if you have a DVT is to have an ultrasound of your legs. There are alternative types of compression that may be used and a compression pump device may also be used when standard compression is difficult, but these methods should be discussed with your physician to see if appropriate for you.

Rick1555: My father’s legs are continuously swelling on and off. He believes it is just because of his age and him not being able to walk as well as he used to. Do you think it can be more than that, possibly DVT?

Carmel_Celestin,_MD: Leg swelling in many cases is caused by decreased activity as it can affect the return of blood flow back to the heart, but has many other causes also, including DVT. Your father should see a physician for a full evaluation.

Eric1964: How does someone know if they are having a pulmonary embolism?

Carmel_Celestin,_MD: Usually the signs and symptoms of pulmonary embolism include chest pain, palpitations, shortness of breath. At times, it is very subtle or even silent. If there are any concerns about this, you should seek medical attention immediately.

Adka890: My brother and I always have swollen ankles/feet after we’ve been in a car for a long period of time for a road trip and after plane rides. Should we be concerned? Can this be DVT?

Carmel_Celestin,_MD: Although this is not likely to be DVT and more likely due to venous insufficiency with pooling of blood from having the legs in a dependent fashion, this question would be best answered by a physical and exam as in some cases DVT's can occur as a result of prolonged car rides. This is diagnosed with an ultrasound.

Blueeyes55: My friend has had a stroke in the past and was just told she had a DVT. Does her past increase her risks of having another stroke or embolism?

Carmel_Celestin,_MD: That is a good question that I would not be able to answer based on the limited historical information provided. Risks of recurrent strokes and embolism are based on why they occurred and the patient's history.

books4bert: I live in Bisbee, AZ. What kind of Dr. do I look for? Are they called vascular medicine specialists or should I see a cardiologist?

Carmel_Celestin,_MD: A vascular medicine specialist would be best suited for your needs.


Medication Therapy

Tom724: Since developing DVT three years ago, I have been using approximately 7mg Warfarin/day. I am considering switching to Eliquis, but my doctor said it has not yet been approved by the FDA for treatment of DVT. He said the study has been completed, but the FDA has not made a ruling. What is the status? Do you recommend moving from Warfarin to one of the anticoagulant?

Carmel_Celestin,_MD: The new anticoagulants (including Eliquis) are approved for the treatment of DVT. The decision to switch to another agent is a discussion that must be undertaken by you and your physician as to pros and cons and based on your clinical profile.

Olga Enriquez: In 2008 after a hallux valgus (bunion surgery), I developed DVT. The blood clot was diagnosed in my upper leg in the groin area. I have been on 4 mg of Warfarin and wear 20/30 compression socks/stocking during the day. As per the doctor the DVT is chronic and will be on Warfarin for the rest of my life (I'm 64 years old). What are the effects of this drug in the long run? Is there a successful surgery that can resolve DVT? I also have acid reflux and Achalasia.

Carmel_Celestin,_MD: There are no long term effects of warfarin, but the longer you are on anticoagulant medications, the longer you are at increased risk of bleeding from them. This is a good question to discuss regarding the pros and cons with your physician. There are times when the blood clots do not dissolve completely and become chronic, almost like scar tissue. This is of no harm or threat and is not typically treated with any surgery due to the old nature of the clot.

miamickey: I was diagnosed with aggressive case of psoriatic arthritis and a month later I had a pulmonary embolism? Does psoriatic arthritis cause hypercoagulability? Would I be wise to stay on Coumadin for rest of my life? I also have two other autoimmune conditions, hypercholesteremia, and several heart issues including AFib and Atrial Sepal Defect. Thanks for any info.

Carmel_Celestin,_MD: This is a great question. There is an association with inflammatory and autoimmune conditions and venous thrombosis. The question as to if you need to be on anticoagulants is a discussion that may be undertaken with your doctor.

Lily0907: My father was just prescribed Warfarin. Is this a medication he will have to continue taking for the rest of his life or until some improvement is made?

Carmel_Celestin,_MD: I am not able to answer your question based on the information provided. The duration of warfarin is based on why he is taking the drug and other risk factors that may play into why he should or should not continue the drug.

Diver561: Other than blood thinning medication, what other treatment options are available for DVT?

Carmel_Celestin,_MD: Blood thinning (or anticoagulants) are the standard of treatment for DVT. At times, lytic agents (clot busters) are used, but this is still followed by blood thinners.

Trykkergirl: I failed to mention earlier when asking about symptoms of DVT, that I think I have a valve recurrent Afib persistent type since it is controlled with 100mg Flecainide twice daily (mild moderate mitral valve regurgitation, but not other changes to heart). I hate and don't take Warfarin because I cannot eat healthy foods I love since I am an inconsistent eater (but LOVE greens, broccoli, dark berries, cabbage, etc.) and when I took it, never could keep INR in range. I can't afford Eliquis, and other novel anticoagulants. I take baby Aspirin, Metaprolol 25 and Lisinopril HCTZ 10/12.5 all once daily. Am I at major risk for stroke? I can feel it when I go into Afib. Once for 30 minutes in last year. When not in Afib, is it OK to use dual headed massager on legs due to swelling and them being achy? Could that cause a stroke or DVT?

Carmel_Celestin,_MD: Your question would be best addressed with a visit with a physician. I am also not able to comment on the use of a massager without a history and physical exam.

Beachbum67: When it comes to DVT, do you think there is a difference whether the anticoagulant is given orally or by injection?

Carmel_Celestin,_MD: In general, the anticoagulants (whether oral or injected) are similar in terms of effectiveness. There are a select group of patients where one may be better than the other, based on their medical history and comorbidities.

JanetBrown47: How would I know whether my anticoagulant is working?

Carmel_Celestin,_MD: This depends on which anticoagulant you are taking. Coumadin/warfarin is monitored to see if it is within a therapeutic range. Some of the medications are weight based and their effectiveness is based on that. Their levels can also be tested if needed. The newer oral agents do not need to be monitored. Their effective doses were studied prior to approving them. If you are doing better, that is a clinical sign the medication is working.

Katiecookbook: How accurate and reliable is AngioJet mechanical thrombectomy?

Carmel_Celestin,_MD: Angiojet is an effective method of treatment of thrombosis. This method of treatment is being evaluated with clinical trials.


Lifestyle Changes & Other Therapies

Rvguywpb: My mother was diagnosed with DVT a few weeks ago. Are there any lifestyle changes she should be making?

Carmel_Celestin,_MD: The main lifestyle changes in someone with DVT should make include taking anticoagulants, wearing support socks, and remaining active. She should avoid any contact sports and roller coasters due to bleeding risk on anticoagulants. If she is on warfarin, there are dietary changes that also need to be made.

KatieMcG213: Does wearing compression socks help with the clot other than just easing the pain?

Carmel_Celestin,_MD: It is mainly to help the pain and swelling, but there are reports that it may even help the clot dissolving faster.

Rockfan2465: My grandmother is 80 years old and has diabetes along with a DVT. Do you think she is a candidate for thrombolytic therapy when it comes to treatment?

Carmel_Celestin,_MD: Thrombolysis is usually reserved for acute (within a couple of weeks) and severe cases of DVT. There are elevated risks of major bleeding associated with thrombolysis, so most cases of DVT are treated with anticoagulation alone.

Chicago78: Does someone with a DVT need to make sure their blood pressure levels remain normal? Does high blood pressure increase the chances of an embolism?

Carmel_Celestin,_MD: There is no known association between blood pressure and risk of DVT.

books4bert: I have Factor V Leiden and have been dealing with DVT since 1980. I used to wear a custom made Jobst stocking (panty hose due to a clot in left groin area) but now wear knee high open toe Jobst. My left leg is worse than the right and I've had 3 bouts with open wounds develop on my left foot near the ankle, needing an Unna Boot the first time. My question is, is it all right to wrap that part of my foot with padding and Coban wrap under the Jobst on a long-term basis? I would like to avoid further skin break down. None of my doctors seem to know much about my condition or what advice to give me.

Carmel_Celestin,_MD: This is a question that can best be answered during a physical examination with a physician following a review of your complete medical history. I encourage you to make an appointment for a second opinion consultation with myself or one of our other vascular medicine specialists.


For Appointments

To make an appointment with Carmel Celestin, Vascular Medicine specialist or any of the other specialists in the Department of Vascular Medicine at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at my.clevelandclinic.org/florida.


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