Deep Vein Thrombosis

[Siamkid]

Hello

I was diagnosed with Deep Vein Thrombosis 13 months ago and have been prescibed by a local doctor to take 10 Mgs of Warfarin daily. I went for yet another follow up a few days ago and had another ultrasound performed. The clot has gotten larger. It appears that I have become resistant to Warfarin and the doctor has increased my dosage to 15 Mgs on Mondays, Wednsedays and Fridays. The doctor has suggested my problem could be genetic. The next step may be daily injections of Heparin, self administered with doctors instructions.

If anyone knows of a particular doctor and/or hospital that "Specializes" in the treatment of DVT in Bangkok please let me know.

Any feedback is greatly appreciated.

Thank you very much.

Siamkid

[Langsuan Man]

First of all you should be monitoring your Wafarin (called coumadin in the US) level on a weekly basis, especially since you are new to it. It is not unusual for your INR readings to fluctuate but should be within the 2 and 3 range. Any less you need to up your daily dosage, any higher and you need to decrease your dosage

To be perfectly honest with you I would immediately seek another doctor since you should have been put on a regimen of daily Heparin injections immediately after you were diagnosed with DVT, followed up by oral ingestion of Wafarin

Go to a named hospital and see a Hemotologist who will monitor your INR blood levels. In Thailand the normal process is first be seen by a GP, who will then refer you to a Cardiologist, who in turn will send you to a Hemotologist. Jump the chain and see a Hemotologist right away

BTW. You might be on Wafarin for the rest of your life, even if the blood clots disappear, since most doctors believe the gains from Wafarin use to prevent DVT is worth the dangers of low blood clotting in the case of an accident

See this web site for information on Coumadin Drug Interactions

http://www.drugs.com...n,coumadin.html

[Sheryl]

I suggest this doc at Bumrubngrad

http://www.bumrungrad.com/doctors/Piyanut-Pootracool

[Siamkid]

Langsuan Man

Thank you very much for your input. It's greatly appreciated !!!

Sheryl

Thank you very much for your reccomendation. It looks like a trip to Bangkok is in order in the very near future.

Do either one of you know where I can buy an INR test kit for home use ???

Best regards.

Siamkid

[Sheryl]

See this thread

[Langsuan Man]

Follow up on the machine per Sheryl's post reference. I was fortunate that I was able to get my US Hematologist to write an RX for the INR testing machine and my insurance paid for it. It cost's me $26 per month for the co-pay but the convenience of being able to monitor my levels every week is wonderful.

I don't know what your situation in Thailand is but I have the luxury of being able to go back to the US every year so I take advantage of my medical insurance there and bring back what I need for the 8 months I spend here

The machines are covered by Medicare, but once again that only helps if you are in the US or visit regularly

[h5kaf]

The advice you have been given here is spot on - you should take heed.

a. A DVT (especially in the larger veins i.e. leg) can kill you so it is not something to be taken lightly.

b. Low mollecular weight heparin is usually given straight away together with warfarin. Warfarin takes a while (3 or 4 days)to get to therapeutic levels in the blood, thus the heparin for immediate cover.

c. Warfarin takes a good while to establish the required level of cover, given different peoples eating and drinking styles. You will need to learn what you can eat and drink and this over a fair period of time (sometimes years).

d. In the early stages it is advisable to get blood concentration levels checked by a haematologist who will make the necessary dosage adjustments. Self adjustments at this early stage can be dangerous.

e. Alcohol increases the effect of warfarin whilst spinach is high in vitamin K which aids clotting and reduces the effect of warfarin. These are just 2 of a number of things you need to know.

As a matter of interest there was discovered, in the 1990s, a blood condition known as 'Leiden V mutation'. I know very little about this, but I have it and have passed it on to my sons. It apparently means that I have a far greater risk of clotting as the result of trauma or strains. Unknown before the 1990s this is most probably the cause of my DVTs many years ago when in my 20s. Not sure they can check for it in Thailand but in Australia, UK or the USA it can be picked up.

Have posted this in the spirit of giving information which may be of help. No conflict with other posts.

[richard_smith237]

Last year I suffered a DVT, I thought the minor pain in my leg was simply an injury after playing football (I'm in my 30s).

The thrombosis migrated into my lungs and I required emergency treatment for the resulting Pulmonary Emolism which nearly killed me. I was medivaced to Singapore.

I underwent a treatment of rTPA (which thins the blood to dangerous levels but clears a lot of the clotting - I think of rTPA as a washing up liquid for the blood stream) - I spent a night in a High Dependancy Unit due to risk of excessive bleeding (I bled internally in my arm from a simple needle pin prick after an Arterial blood sample was taken).... I endured a further 7 days of daily Heparin Injections and an additional 5 days switching to Warfarin (INR 2-3), two of which were spent outside of hospital.

Once back in Thailand I saw a cardiologist at Samitivej Hospital who appeared up to date and understood my situation.

I also purchased an INR test kit and self regulated my Warfarin intake (About US$1000). I calibrated my Self Test INR results with a monthly INR blood test at Samitivej. (I needed to self test due to frequent travel).

As I understand it we each respond differently to Warfarin: I managed myself with a dose of between 4-7 mgs, depending on when I might have a few beers (for me there was a 4-5 day lag time between Warfarin ingestion and INR reading - So I would have to plan ahead a little).

To answer your question: Warfarin is a common drug and the Doctors (the ones I spoke with) are well aware of its use. A good hospital will know how to administer it.

13 months is a long time to have a DVT... Are you sure you still have the DVT and you are not simply feeling the effects of Post Thrombotic Syndrome? i.e. When was the last Doppler Ultra Sound you had carried out on your legs ?

I'd be worried that the DVT has not cleared up after 13 months there are further inherent risks. i.e. Stroke, P.E. etc..

A good doctor should be able to assist with stepping up treatment...

Advice I have for anyone at risk of DVT: Take Heparin Injections before any flight longer than 6 hours.

Advice I have for anyone: Wear Compression Socks while flying or after recovery from exercise.

Edit: In addition to h5kaf comments. There are a number of blood screening tests that can be taken to measure for susceptibility to Thrombosis:

Factor V leiden and Prothrombin G20210A mutation.

Protein C, protein S, antithrombin and homocysteine levels.

Lupus anticoagulant and anticardioplipin screening.

Factor V Lieden is not uncommon - Information from the internet (which may or may not be correct) suggests that the Gene Mutation an susceptibility to Thrombosis is common in as many as 7% of Caucasians.

I had all the necessary blood tests in Thailand in Samitivej Hospital. All clear. Apparently the causes of a DVT remain unclear in 50% of cases.

Edited November 18, 2012 by richard_smith237

[richard_smith237]

The Self Test kit I used it now up for sale for anyone who is taking Wafarin and is looking to Self Test rather than undertake the frequent doctor / hospital visits.

[marcusd]

Please seek proper help at a MAJOR HOSPITAL. Warfarin is RAT POISON in other terms. You fyinot become resistant.

PLEASE SEEK PROPER ADVICE. Warfarin is mainly used in heart not leg clots.

Sent from my GT-N7000B using Thaivisa Connect Thailand mobile app

[Sheryl]

Warfarin most definitely is used for DVT and clots elsewhere in the body as it is an anticoagulant. (As a rat poison, its effect is by causing them to bleed internally).

[richard_smith237]

Please seek proper help at a MAJOR HOSPITAL. Warfarin is RAT POISON in other terms. You fyinot become resistant.

PLEASE SEEK PROPER ADVICE. Warfarin is mainly used in heart not leg clots.

Sent from my GT-N7000B using Thaivisa Connect Thailand mobile app

This is a serious topic - Please don't make such alarmist statements as when you have no idea what you are talking of.

If you are unsure and wish to post an opinion please take a moment and research first.

First hand experience:

My Warfarin dosage ranged between 4-7mgs per day. It was prescribed by a Cardiologist in Singapore and another in Thailand.

Warfarin is a very common in the treatment and risk reduction of Thrombosis.

A beer and various foods can swing the INR results somewhat - the Warfarin medication itself had an approximately 4-5 day delay before my INR tests registered in the increase or reduction in dosage between 4-7 mgs to maintain my INR between 2-3.

In my case I took a reduced dosage of 4mgs 4 days before the weekend when I may be having a beer. In periods where I wasn't consuming any alcohol the dosage required to maintain my INR was 7mgs.

I purchased and used my own self test kit to monitor my INR on a daily basis.

[David48]

First of all you should be monitoring your Wafarin (called coumadin in the US) level on a weekly basis, especially since you are new to it. It is not unusual for your INR readings to fluctuate but should be within the 2 and 3 range. Any less you need to up your daily dosage, any higher and you need to decrease your dosage

To be perfectly honest with you I would immediately seek another doctor since you should have been put on a regimen of daily Heparin injections immediately after you were diagnosed with DVT, followed up by oral ingestion of Wafarin

Go to a named hospital and see a Hemotologist who will monitor your INR blood levels. In Thailand the normal process is first be seen by a GP, who will then refer you to a Cardiologist, who in turn will send you to a Hemotologist. Jump the chain and see a Hemotologist right away

BTW. You might be on Wafarin for the rest of your life, even if the blood clots disappear, since most doctors believe the gains from Wafarin use to prevent DVT is worth the dangers of low blood clotting in the case of an accident

See this web site for information on Coumadin Drug Interactions

http://www.drugs.com...n,coumadin.html

EVERYTHING he said ...

EDIT ... just read them all.

EVERYTHING said above except the idiot marcusd are gems of posts.

Edited September 15, 2013 by David48

[David48]

I have suffered a DVT ... I understand what you are going through.

If you have 5 mins, have a read of my story ... a-personal-story-with-a-warning-for-almost-everyone about the DV%T I suffered and you will surprised the number of well wishes ... you are not alone.

Also, I do a bit of the science on it in that thread and also here at a-personal-story-d-v-t-the-science-of-why-and-importantly-how-not-to ... I never finished that one ... but maybe some help to you.

One thing I did learn about the INR reading ... because I never understood the 'must be between 2 and 3 bit.

In laymans terms ... if your INR is '2' ... it means that your blood is twice as thin as 'normal.

Thin blood tends to clot less.

Warfin works just fine ... but the dose and your diet is very important.

Hope that helps a little.

If you change or vary your diet a lot, your INR levels can swing quite considerably.