Patient Education Blog

Clotting Disorders (Thrombophilia): Who Should Be Tested? What To Test?

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Stephan Moll, MD writes… A publication today in the journal Vascular Medicine discusses - for patients and family members – (a) in which patient with blood clots (DVT, PE) to consider testing for a clotting disorder, (b) what tests might be appropriate to do, (c) how the test results influence management with blood thinners, (d) what birth control methods are safe in women with history of blood clots or a clotting disorder,  and (e) in which family members to consider thrombophilia testing (link here for the article).

 

Disclosures:  None

Last updated: April 1st, 2015

 

 

DVT and PE Prevention when Admitted to the Hospital

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Stephan Moll, MD writes (on12/5/2014)… Prevention of DVT and PE in patients who are in the hospital is important.  Hospitals are required to have mechanisms in place that guarantee that patients at risk for DVT and PE get appropriate prophylaxis [reference].  We have developed at the University of North Carolina (UNC) a guidance document (link here; UNC VTE prophylaxis guidance document) as a resource for our doctors to assist in making decisions on which patients to give what type of DVT and PE prophylaxis.  We are making this document available for other doctors and hospitals, to use it as is or modify it as needed.

Recommendations provided in this document are a reflection of current guidelines, clinical evidence, and UNC institutional initiatives.  Patients may look at this document to see what kind of DVT prophylaxis might be appropriate in certain situations, such as surgeries; and they should discuss appropriate prophylaxis with their physicians.  However, this document is not intended to replace individual patient evaluation and management decisions.

Reference

Joint Commission VTE measures (link here)

Disclosures: None

Last updated: Dec 5th, 2014

Aspirin Can Prevent Recurrent DVT and PE

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Stephan Moll, MD writes… For patients stopping blood thinning therapy (anticoagulation) whose deep vein thrombosis (DVT) or pulmonary embolism (PE) was considered unprovoked (i.e. out of the blue and with no obvious triggering, transient cause, such as surgery, hormone use, immobility), aspirin is beneficial in some patients in preventing further clots.  A new publication in the journal Circulation re-confirms findings from two previous studies, showing that aspirin reduces the risk of recurrent DVT/PE by more than a third without significantly increasing the risk of bleeding [ref 1,2,3]. Read the rest of this entry »

Is acupuncture safe for patients taking blood thinners?

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Beth Waldron, Clot Connect program director writes…

Background:  Blood thinners (anticoagulants  such warfarin, Xarelto, Pradaxa, Eliquis, enoxaparin) and anti-platelet drugs (aspirin, Plavix) increase bleeding risk.  Patients taking these drugs are typically advised to avoid activities which might cause increased bleeding, bruising or trauma.

Acupuncture involves the insertion of thin needles through the skin at strategic points along the body. These needles are very thin, much smaller than the hypodermic needles used for phlebotomy (blood draws) and injections.(Ref 1)   Because the needles used are so small, very little bleeding occurs with acupuncture. (2)

The data:

  • A 2014 published study on the safety of acupuncture for patients taking blood thinners found no reports of major bleeding.(3)  Minor ‘microbleeding’—defined as bleeding which stopped within 30 seconds—occurred in only slightly more patients taking an anticoagulant (4.8%) than patients not on an anticoagulant (3.0%).  Patients taking an anti-platelet medication had very little bleeding (0.9%).
  • There was also no significant difference in the amount of bruising which occurred from acupuncture between those taking an anticoagulant (2.0%) or an anti-platelet (1.6%) and those who took neither (1.3%).
  • An earlier study of acupuncture among hospitalized patients taking warfarin, also found very little bleeding and that a higher INR value did not predict a higher risk of  bleeding–bleeding incidence after acupuncture were no different among patients with a low INR (14.6%) and those with a high INR (14.3%). (4)

Summary:   Acupuncture appears to be safe for the patient on a blood thinner.  However as a precaution, inform your acupuncture provider in advance of the procedure that you are on a blood thinner so they can be alert and prepared.

 

REFERENCES

1. UpToDate   http://www.uptodate.com/contents/acupuncture

2. “A Guide to Integrative Oncology”  University of Washington http://depts.washington.edu/integonc/patients/spc/acupuncture.shtml

3. Kim et al. The safety of acupuncture treatments for patients taking warfarin or antiplatelet medications: A retrospective chart review study European Journal of Integrative Medicine, May 17, 2014. http://www.sciencedirect.com/science/article/pii/S1876382014000626

4. Miller et al. Acupuncture treatment for hospitalized patients on anticoagulant therapy—a safety study  BMC Complementary and Alternative Medicine 2012 (Suppl 1) p 107