Edema and pulmonary embolism advice dr wise s I nurse

kittim · 09-02-2011, 07:05 PM

C3/4 incomplete walking quad. Diagnosed and Hospitalized for treatment of pulmonary embolism. One week ago. Had blood clot in right leg immediately after injury 8 yrs ago. Now has one in left leg, stomach and lungs. Small in lungs and stomach. Home 1 day and fell

but ok. now I'm taking care of him. He is on coumadin was not before this incident for more than 6 years.

His left leg is quite swollen. Telephone pole like. Should we use Ted hose? Our dr, not sci dr says contraindicated, but he knows nothing about sci patients. Post first blood clot in rehab, they kept Ted hose on him. What should we do?

SCI-Nurse · 09-02-2011, 10:52 PM

Is he stable on his Coumadin dosage already? We do not allow compression hose, or ROM or walking with a DVT until the Coumadin dosage is stablized, which can take several weeks or longer. After that, a low to moderate compression stocking is OK, as long as you can get them on (and have the right size which may be different now) without undue rubbing or massaging of the fleshy part of the leg. He is at risk for the development of phlebotic syndrome with chronic severe edema and risks for venous leg ulcers.

Is he on any new meds? Has he had a recent hospitalization or injury to his legs or pelvis? Been more sedentary or on bedrest? Been on a long plane or car ride? While it is most common for DVT and PE to occur in the first 2 years post injury (esp. in the first 3 months), people with SCI are at risk for this (more so than ABs) forever.

With a second DVT like this, it is likely that they will recommend that he now stay on Coumadin for the rest of his life. It will be critical to do everything possible to avoid falls and injuries as this can lead to serious bleeding, esp. from any blows to the head. You should discuss this with his primary care physician, and if possible, a SCI board certified physician as well.

(KLD)

kittim · 09-02-2011, 11:20 PM

He is not stable yet on his Coumadin dosage and not on any new meds, other than the Coumadin and Lovenox (2 injections bid for 6 days now DQ'd). He had a vena cavagram done while in the hospital, filter still in place.

He got very dehydrated and was down on his nutrition, feeling lazy and didn't go to the market for himself. His initial symptoms were the return of moderate to severe spasticity, (is this related?) swelling in the lft leg (previous clot had been in right) and occasional mild shortness of breath.

They admitted him to the hospital. He is 8 yrs post. They say he has large clots some old some new (diagnosed by CT Scan with contrast). D-dimer was 13? They started him on Lovenox. Kept him as inpatient 5 days.

He lives alone in the desert. I picked him up since he seemed unable to be on his own and brought him to my house. 3 hour car ride. He is moving around a little bit, getting some strength back. He was very weakened and depressed by the whole ordeal. I'm concerned about the falling cuz he does it with some frequency. I guess there are always trade offs, pulmonary embolism vs subdural hematoma. Quite a choice...

Did discuss the possibility of his falling with his pcp. There are no SCI physicians available.

Have been unable to get him in to check inr. Noone here does it by finger stick, have to send to lab... what a pain. The dr did suggest that we might change him to another med that does not require testing. idk what it is called.

kittim · 09-06-2011, 10:52 PM

Our dr. Mentioned that this drug might be a good idea at some point since bob will have to be on coumadin for the rest of his life. Is this drug really a good alternative. No testing required sounds I ticking.

SCI-Nurse · 09-07-2011, 03:29 PM

see previous post for response to this question.

AAD

smokey · 09-07-2011, 04:53 PM

KLD, I had 2 PE's back in 1977 when I was busted up. I had an Adams-DeWeese clip placed in my inferior vena cava to catch any more blood clots. Although I always wear compression stockings now and was on heparin in the hospital back then....I have never been on coumarin or any blood thinner since then.

09-02-2011, 07:05 PM	#1
kittim Senior Member Join Date: Nov 2005 Location: CA Posts: 255	Edema and pulmonary embolism advice dr wise s I nurse C3/4 incomplete walking quad. Diagnosed and Hospitalized for treatment of pulmonary embolism. One week ago. Had blood clot in right leg immediately after injury 8 yrs ago. Now has one in left leg, stomach and lungs. Small in lungs and stomach. Home 1 day and fell but ok. now I'm taking care of him. He is on coumadin was not before this incident for more than 6 years. His left leg is quite swollen. Telephone pole like. Should we use Ted hose? Our dr, not sci dr says contraindicated, but he knows nothing about sci patients. Post first blood clot in rehab, they kept Ted hose on him. What should we do? Last edited by kittim; 09-02-2011 at 07:06 PM. Reason: Clarify typo

09-06-2011, 10:52 PM	#4
kittim Senior Member Join Date: Nov 2005 Location: CA Posts: 255	Pradaxa-is this an option Our dr. Mentioned that this drug might be a good idea at some point since bob will have to be on coumadin for the rest of his life. Is this drug really a good alternative. No testing required sounds I ticking.

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09-02-2011, 10:52 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,341	Is he stable on his Coumadin dosage already? We do not allow compression hose, or ROM or walking with a DVT until the Coumadin dosage is stablized, which can take several weeks or longer. After that, a low to moderate compression stocking is OK, as long as you can get them on (and have the right size which may be different now) without undue rubbing or massaging of the fleshy part of the leg. He is at risk for the development of phlebotic syndrome with chronic severe edema and risks for venous leg ulcers. Is he on any new meds? Has he had a recent hospitalization or injury to his legs or pelvis? Been more sedentary or on bedrest? Been on a long plane or car ride? While it is most common for DVT and PE to occur in the first 2 years post injury (esp. in the first 3 months), people with SCI are at risk for this (more so than ABs) forever. With a second DVT like this, it is likely that they will recommend that he now stay on Coumadin for the rest of his life. It will be critical to do everything possible to avoid falls and injuries as this can lead to serious bleeding, esp. from any blows to the head. You should discuss this with his primary care physician, and if possible, a SCI board certified physician as well. (KLD)

09-02-2011, 11:20 PM	#3
kittim Senior Member Join Date: Nov 2005 Location: CA Posts: 255	He is not stable yet on his Coumadin dosage and not on any new meds, other than the Coumadin and Lovenox (2 injections bid for 6 days now DQ'd). He had a vena cavagram done while in the hospital, filter still in place. He got very dehydrated and was down on his nutrition, feeling lazy and didn't go to the market for himself. His initial symptoms were the return of moderate to severe spasticity, (is this related?) swelling in the lft leg (previous clot had been in right) and occasional mild shortness of breath. They admitted him to the hospital. He is 8 yrs post. They say he has large clots some old some new (diagnosed by CT Scan with contrast). D-dimer was 13? They started him on Lovenox. Kept him as inpatient 5 days. He lives alone in the desert. I picked him up since he seemed unable to be on his own and brought him to my house. 3 hour car ride. He is moving around a little bit, getting some strength back. He was very weakened and depressed by the whole ordeal. I'm concerned about the falling cuz he does it with some frequency. I guess there are always trade offs, pulmonary embolism vs subdural hematoma. Quite a choice... Did discuss the possibility of his falling with his pcp. There are no SCI physicians available. Have been unable to get him in to check inr. Noone here does it by finger stick, have to send to lab... what a pain. The dr did suggest that we might change him to another med that does not require testing. idk what it is called.

09-07-2011, 03:29 PM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,341	see previous post for response to this question. AAD

09-07-2011, 04:53 PM	#6
smokey Senior Member Join Date: Jul 2001 Location: Massachusetts, USA Posts: 1,865	KLD, I had 2 PE's back in 1977 when I was busted up. I had an Adams-DeWeese clip placed in my inferior vena cava to catch any more blood clots. Although I always wear compression stockings now and was on heparin in the hospital back then....I have never been on coumarin or any blood thinner since then.