dvt treatment

[zap]

Ok, broken foot has become more problematic.

Flew down to Florida (2+ hour flight, doc said ok) last Thursday. Later that day I noticed some discomfort in my calf and got worse each day. I thought it was a cramp but by Sunday morning something told me to go to the er to have it checked out. I was scheduled to fly back home Monday morning.

Ultrasound found a clot in the calf so doc quickly gave me a shot of Lovenox. Started Coumadin as well. Now I'm waiting to get inr up to 2-3 so they will release me and fly home. After 2 days the level has gone from .9 to 1.1 and now back down to 1.0.

Itching to get out of the hospital and get to a hotel (my wife is flying down) but I'm getting conflicting info from nurses and docs. Initially I was informed that I could inject Lovenox as out patient, take Coumadin and get tested daily until my inr gets to 2 to 3 then fly home. Earleir I learned they want to keep me until the inr reaches 2+.

Frustrated so wondering if good folks here have info that might help me get educated on this matter.

Thanks in advance.

[bzbvh5]

If you have to take coumadin for the long term, see if you doctor will let you take warfarin instead. It's a lot cheaper and does the same thing. Both of these in high concentrations make a great rat poison. Also if it is a long term thing, find a heart clinic that has a prick your finger and let the machine post immediate results test. That drawing blood and waiting a few days for results is more expensive and time consuming.

Plan on having your INR not being between 2 and 3 for about a week and a half. To be safe, I'm sure they started you on 5mg per day which is probably not enough and they know that. After a few days they will up the dose to get you closer. I do about 10mg a day and it took longer than I wanted to get to that level.

Lovenox is very expensive, and if your insurance is like mine they will only pay for a few days of those twice a day injections. Just be prepared for the sticker shock.

They don't necessarily have to keep you in the hospital while the you do the lovenox waiting for the correct INR reading. You can self administer; the lovenox people have even made a video of how to do it.

My best advice is: Lower your chair at work when you get back and while on the plane ride home, get up every 20 minutes or so and walk up and down the aisle once or twice.

[Smiley]

Zapper, sorry about your issues, Why has this happened?

[BCS]

They don't necessarily have to keep you in the hospital while the you do the lovenox waiting for the correct INR reading.

+1. There is also no reason not to fly home until INR is therapeutic as long as you are on Lovenox.

[biker72]

You can't be too careful if you already have a clot in your leg. The treatment you've been given should dissolve it. With any luck this is a once in a life time event.

I've never taken Lovenox but have a lot of experience with coumadin-warfarin. Hopefully you won't have to take it long term.

[zap]

Zapper, sorry about your issues, Why has this happened?

Good question and one I have been asking. It's not like I've been in a cast for 6 weeks. Airboot has allowed me to take my foot out and wiggle bits about after week and a half from break.

Might be why they are keeping me another day, docs keep taking blood for other tests. Trying to get info is more difficult than expected.

Right not it looks like i won't be on coumadin long term. Will stop when clot is gone 3-6 months, or less.

Bzbvh5, thanks for the info regarding clinic pin prick test. I understand with coumadin-warfin that initially (first week or two) I have to go many times to ensure dosage is correct.

This is my first hospital stay and it has been an experience. I strongly recommend having an advocate to take care of affairs.

[sevencyclist]

The treatments won't dissolve the clots. However, they will prevent further clots from piling on to the lesion.

The lovenox should do the jobs until coumadin kicks in. If there are concerns (renal or weight issues), anti Xa level can be checked to make sure the dosage of lovenox is therapeutic.

Hope the rest of treatment is smooth.

[CNY rider]

Good question and one I have been asking. It's not like I've been in a cast for 6 weeks. Airboot has allowed me to take my foot out and wiggle bits about after week and a half from break.

Might be why they are keeping me another day, docs keep taking blood for other tests. Trying to get info is more difficult than expected.

Right not it looks like i won't be on coumadin long term. Will stop when clot is gone 3-6 months, or less.

Bzbvh5, thanks for the info regarding clinic pin prick test. I understand with coumadin-warfin that initially (first week or two) I have to go many times to ensure dosage is correct.

This is my first hospital stay and it has been an experience. I strongly recommend having an advocate to take care of affairs.

The "other tests" don't matter in the short run.
You can get the results of them sent to your home town Dr. when they come back.
Right now you should direct your energy to checking out your insurance coverage for Lovenox or other low molecular weight heparin like Arixtra which is once a day.
If you are covered or can afford a 7-10 day supply then there is absolutely no reason for you to stay in the hospital.
Hospitals are only for really sick people. You have a DVT but it sounds like you are otherwise OK; being in the hospital longer can only do bad things for your health (Trust me on this one).

[cdn_bacon]

I'm not in any way a medic or related to the medical field, BUT, I did help my father-in-law with some DVT work for a pharmacy and here is the info from them if this in any way helps you. Or I could be way of and this is a waste of time. (sorry if it's the latter)

http://www.leo-pharma.ca/C1256AD9004FB242/adbdi/8611B2E6B40C49D1C125758400529E49?OpenDocument

[bzbvh5]

[Right not it looks like i won't be on coumadin long term. Will stop when clot is gone 3-6 months, or less.
I understand with coumadin-warfin that initially (first week or two) I have to go many times to ensure dosage is correct.[/QUOTE]

You are getting some good information from someone. You are correct on both accounts. You will only be a long term candidate if you have another occruance.

The term is recanalization. The clot won't necessarily ever be gone depending on the severity. I found this on the internet. recanalization /re·can·a·li·za·tion/ (re-kan″ah-lĭ-za´shun) formation of new canals or paths, especially blood vessels, through an obstruction such as a clot.

[znfdl]

Zap, lets hope you have a speedy recovery......

[SEABREEZE]

Had a simular experience about a year ago, first time was in hospital since a kid. While there I got a clot in my leg, they put me on heperin drip, eventually weaned me off and onto coumadin-warfin, then released.
Got off the coumadin-warfin as soon as I could

Hang tough Zap.


How did you break your leg in the first place

[biker72]

Trust me on this one. Your insurance company does not want you in the hospital one second longer than necessary. You're there for a good reason.

[tkbike]

Three years ago I had a DVT in my femoral artery after a six hour abdominal surgery. I gave myself the twice daily Lovenox injections for 6 weeks on an outpatient basis before moving to Coumadin for six months. I was never able to go less than two times per week for my INR test because of the weight fluctuations after surgery. You have to be very careful of your diet while on Coumadin, especially if your a big spinach eater like me!

Good Luck in your recovery

[etu]

bridging lovenox is a great way to get patients out of the hospital without having to wait for the coumadin to become therapeutic

do this routinely for our patients

are you sure there isn't some other active issue here?

[zap]

are you sure there isn't some other active issue here?

They are looking into it.

My blood pressure was high too, 140-150/90 range but visiting my dad might have something to do with it. Pressure is down now with help from meds.

My inr has yet to go up so will be on Lovenox until inr hits 2. Current warfin dose is 7.5mg.

I will be released soon and will meet someone at the hotel to review inr check procedures etc.

Staying in bed for days while trying to get info from docs and watching others has been an experience.

Thanks to all who responded.