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Thread: Pulmonary embolism -medical advice needed

  1. #1

    Pulmonary embolism -medical advice needed

    Hello, haven't posted here in a year. My husband c3/4 Inc. Just diagnosed with pulmonary embolism. He had filter inserted in his groin when he was first injured. He did experience a blood clot early on, but nothing since. Wondering if the clots are developing above the filter or could they have leaked through?

    There are several clots in both lungs, both old and new. Dr indicated that they will need to find out why they are forming. Any comments dr. Wise?
    Last edited by kittim; 08-27-2011 at 01:52 AM. Reason: Add detail

  2. #2
    You can get clots above the filter.The legs are the most common but.. Arms etc..

  3. #3

    Dr. Wise and SCI Nurse

    His initial symptoms were the return of moderate to severe spasticity, (is this related?) swelling in the l leg (previous clot had been in right) shortness of breath.

    They admitted him to the hospital. He is 8 yrs post. They say he has large clots some old some new. D-dimmer was 13? They started him on Lovenox. I don't know how long they will keep him as inpatient. What can we expect in the way of treatment. I am assuming Lovenox bid for 10 days then maybe coumadin after? How worried should we be? Thanks as always for your support.

    He was living alone and independantly prior to this. The increased spasticity was causing real problems. Can we expect the spasticity to return to the way it was pre-embolism? I know there is no crystal ball.
    Last edited by kittim; 08-27-2011 at 11:22 AM. Reason: added detail

  4. #4
    The filter should prevent the clot from going to his lungs. They need to check and see if it is in the right place. We usually put people on Warfarin/Coumadin for the rest of their life usually after the higher dose, we put them on a lower maintenance dose. It sounds like he was doing well for many years but do they think he has some type of blood disorder( not that sci isn't enought) but some people have clotting issues ( some mild irregularity ) that are picked up when they get clots. The chance in
    SCI is supposed to be lower after the first year post injury but....Good thing he caught it in time.
    Family hx???

  5. #5
    Did they actually see the clots in his lungs with a scan? Clots can trigger spasticity but spasticity also can get worse and hard to tell if the spasticity might have caused less moveent or something and hence the clotos and PE.Some run a low grade fever with a PE also.

  6. #6
    They did a CT scan with contrast and saw numerous clots. He had minimal spasticity prior to almost fainting Monday. But i think hes was dehydrated. Vascular surgeon going in vena cavagram today possible ivf revision. We r at a hospital and Dr we know nothing about. A little concerned.

  7. #7
    Was he on coumadin before his blood clots?

    Most doctors will tell you that you need to be on coumadin or some sort of anti-coagulation for life if you have an IVC filter in place. This is because the filter itself can become clogged (platelets and other things like to stick to it and can occlude it - usually edema gets very bad if this is happening), and because the filter "slows down" flow of blood from the legs and back to the heart (and this slow blood in your leg can form clots more easily) AND because over time blood clots in your legs may be able to sneak by the filter.

    Your body actually starts to grow new blood vessels AROUND the filter. Takes a couple of years. This is the body's response to this filter slowing down the blood flow. Once the extra blood vessels are there, blood clots that form in the legs can now sneak around the filter, and still get to the heart and lungs.

    There seems to be a lot of disagreement about how to manage patients with SCI and filters, and SCI and blood clots. I would think about getting a second opinion, talking both with an experienced hematologist and your SCI doc (if he is very knowledgeable... ours isn't knowledgeable about this stuff). I would ask for a consult with hematology before jumping to surgery. IVC filter revisions are NOT commonly done.

    Be sure to talk to the doctor extensively before considering surgery. How many revisions have you done? How many in patients like us? Why are our alternatives?

    Why not just take coumadin at this point? This will protect you from blood clots in the future, regardless of what's going on with the filter.

    My Dad has an IVC filter, and he is on coumadin for life, with an INR goal of 2 (we're aiming for the low end, as he is a walking para who has had many falls, so bleeding is a risk).

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