After blood clot, take med forever, or pause, start again?

[Shop mak]

To those who had blood clot, do you take blood thinning medicine forever, or pause after 3 months and start again 3 months later for 3 more months?

 

Got different answers from hospitals, so unsure what to do.

 

Problem when one need any other non life threatening surgery, as one need to be off blood thinning medicine for a while ahead.

Another small problem, avoid old style shavers, avoid cuts, bleeding.

 

After blood clot once, one will always be worried if or when next clot will come, right?

Have any of you had blood clot a 2nd time?

 

Hope people with personal experience will chime in, and also @Sheryl

 

Thanks all, in advance.

[poppysdad]

Shortly after my first AstraZeneca covid jab I experienced severe breathing problems, I went to my usual clinic who put me on oxygen and a nebuliser, took a blood test and sent me for chest X-ray. 
The blood test along with the X-ray showed clots on my lungs, I was prescribed a rather expensive blood thinner for 2 weeks and the next test came back all clear and my doctor decided I not need them anymore and have had no problems with clotting since. 

[watgate]

After my second blood clot back in the U.S. more then 10 years ago, my hematologist checked my blood and determined that I had a blood disorder. She said I would have to go on a blood thinner for the rest of my life since I was prone to DVT. Initially it felt like a death sentence but with so much else in life you learn to live with it. Actually, living in Thailand is a Blessing because I go for periodic blood tests (INR) at the local hospital to make sure I am within the therapeutic range. Not only is the blood test very cheap but also I am in and out in no time. Back  in the U.S it was a royal pain in the <deleted> to have my blood checked and then you had to wait a day or 2 for my Dr to call me with the results.  Good luck.

[ozimoron]

3 minutes ago, watgate said:

After my second blood clot back in the U.S. more then 10 years ago, my hematologist checked my blood and determined that I had a blood disorder. She said I would have to go on a blood thinner for the rest of my life since I was prone to DVT. Initially it felt like a death sentence but with so much else in life you learn to live with it. Actually, living in Thailand is a Blessing because I go for periodic blood tests (INR) at the local hospital to make sure I am within the therapeutic range. Not only is the blood test very cheap but also I am in and out in no time. Back  in the U.S it was a royal pain in the <deleted> to have my blood checked and then you had to wait a day or 2 for my Dr to call me with the results.  Good luck.

I strongly recommend you buy a patient self test kit and do your own testing. My haematologist told me that there isn't any reason that patients should still be on warfarin these days. After 2 years on warfarin he changed my medication to Eliquis (apixaban). Have a talk to your doctor and ask for a referral to a haematologist.

 

I used to pay 1500 baht for the INR test at a Pattaya hospital before I bought the kit. The biggest pain was not being able to eat high vit K foods.

[watgate]

1500 baht. Wow I was paying 250 baht for the INR test at McCormick Hospital in Chiang Mai and now am paying 125 baht at the local hospital in Isaan. It is convenient and very cheap.

[ozimoron]

OP, what kind of blood clot did you have and was the blood disorder genetic? There is a genetic disorder which is relatively common among caucasians.

 

Inherited thrombophilia comes in several forms. The most common are factor V Leiden mutation, which 1 in 20 people of European descent have, and the prothrombin G20210A gene mutation or factor II mutation, which happens in 2% of the population.

 

https://www.webmd.com/dvt/thrombophilia-overview

 

I have the second mentioned gene mutation but not the first. After an abdominal blood clot back on 2019 I was prescribed warfarin and told I'd be on it forever because they could not find a cause (idiopathic). The specialists told me that the gene mutation was associated with blood clotting but not the cause of it. In my first annual review the specialist told me the chance of a recurrence while on warfarin was highly unlikely. They told me that warfarin was prescribed as it had better efficacy against abdominal clots but worse against cerebral clotting.

 

In a subsequent bladder cancer check following blood in my urine (gross haematuria) the gastroenterologist suggested that nobody should take warfarin anymore and that I should change to a doac. My bladder and kidneys were found to be healthy. He said that blood in urine was common and annual or less frequent bouts of it weren't necessarily cause for concern.

 

In my next annual review the haematologist recommended I change to Eliquis so I did so. That relieved me of the burden of frequent INR tests and dietary restrictions. I did express concerns about the lack of an antidote but he assured me that issues were quite rare. He recommended Eliquis because it was a twice a day medication and so had a half life of 12 hours.

 

In the last review, a new haematologist wanted to take me off any medication until I told him I was going to Thailand when he said I should stay on them as a precaution. He said that in Australia I would be less than 4 hours from an ER ward and so the risk was acceptable.

 

Obviously I can't comment on the 3 months cycles but I would personally be very reluctant to do that. You should get an opinion from a hospital in your own country for this.

[ozimoron]

6 minutes ago, watgate said:

1500 baht. Wow I was paying 250 baht for the INR test at McCormick Hospital in Chiang Mai and now am paying 125 baht at the local hospital in Isaan. It is convenient and very cheap.

The tests I had were not the modern fingerprick tests. I was also getting tests weekly because any time out of range is very dangerous.

Edited February 26, 2023 by ozimoron

[Skipalongcassidy]

I have been taking warfarin since 2009... double pulmonary embolism... as a result of DVT... I have an IVC Filter...  I have had one INR test in the last year... I can tell when my therapeutic range is ok... eliquis very expensive 

[ozimoron]

1 minute ago, Skipalongcassidy said:

I have been taking warfarin since 2009... double pulmonary embolism... as a result of DVT... I have an IVC Filter...  I have had one INR test in the last year... I can tell when my therapeutic range is ok... eliquis very expensive 

It is expensive. $200 a month in Thailand. I forgot to mention that. I brought a supply from Australia where it's covered by PBS although still expensive.

 

Out of curiosity, how can you tell if your INR in within therapeutic range? You should also state here for the benefit of others whether your decision to take an INR test only once a year was recommended or endorsed by a doctor or not.

[Sheryl]

There is no one size fits all answer to this. Depends on what type of clot you had and what is believed to have caused it. 

[crouchpeter]

5 hours ago, ozimoron said:

It is expensive. $200 a month in Thailand. I forgot to mention that. I brought a supply from Australia where it's covered by PBS although still expensive.

 

Out of curiosity, how can you tell if your INR in within therapeutic range? You should also state here for the benefit of others whether your decision to take an INR test only once a year was recommended or endorsed by a doctor or not.

In Australia it's $7 a month with a health card or pension. Otherwise, about $40/month. Real cost is almost $100/month. You can get Apaxiban in Thailand for about 3,500 baht, up to 5,000 baht, a month. An Indian generic, Apigat, is about 1,500/ month. One 6 month supply got through, but they confiscated my last lot, (no scrip), so in the end, not worth it! Better to go to Oz if you're a pensioner, and see the vascular guy, or the cardiologist, and try for 2 prescriptions; ie. 12 months supply. The savings will cover your airfare with Scoot or AirAsia!

[Skipalongcassidy]

22 hours ago, ozimoron said:

 Out of curiosity, how can you tell if your INR in within therapeutic range?  

By the throbbing in my legs... and no this method is not prescribed by a doctor nor is it approved by big pharma