Archive for the ‘Special situations’ Category
Can Athletes With DVT or PE Return To Play? Fact-Based Rather Than Emotional Reasoning
Stephan Moll, MD1, Joshua Berkowitz, MD2, Philip Blatt, MD, FACP3
Every so often news hit the media that a prominent athlete has had a blood clot: NBA athlete Chris Bosh and NHL’s Steven Stamkos most recently, NBA’s Mirza Teletović and NHL’s Cody McCormick in 2015, tennis player Serena Williams in 2011 Read the rest of this entry »
Stephan Moll, MD writes… Interesting observations published in the last 2 weeks: Heavy menstrual bleeding appears to occur more commonly with Xarelto® than with warfarin [ref 1] and may be also more common with Xarelto® than with Eliquis® [ref 2]. Read the rest of this entry »
Stephan Moll, MD writes… Interesting and relevant publication this week [reference 1]. It is well known that estrogen–containing birth control methods (pills, vaginal rings, patches, injectables) increase the risk for DVT and PE. As women on blood thinners may have heavy menstrual bleeds, hormonal therapy may be considered to decrease the bleeding. Also, women on blood thinners may want to choose a method for contraception other than a progestin IUD (Mirena® IUD, Skyla® IUD).
The newly published study Read the rest of this entry »
Stephan Moll, MD writes… In general: “Yes”. Many people who take blood thinners are able to safely dive. However, there are a few things to consider for the individual on blood thinners who wants to go scuba diving: Read the rest of this entry »
Stephan Moll, MD writes… Interesting study: Are commercial airline pilots at increased risk of DVT and PE, referred to collectively as venous thromboembolism (VTE) [ref 1]? One might think so, as air travel is an established, although only weak, risk factor for VTE [ref 2,3]. This new study found, however, that the risk of VTE is NOT increased in airline pilots.
Study design: This study asked commercial airline pilots in Holland per questionnaire whether they had had a VTE, their risk factors for VTE, and the number of flight hours per year. The rate of VTE was compared to the general Dutch population and to a population of frequently flying employees of multinational organizations.
Results: 76 % of the pilots who had been sent the questionnaire responded, so that 2,630 pilots were included in the study. Six VTE were reported, yielding an incidence rate of 0.3/1000 patient-years. This incidence rate was slightly lower than in the general population and lower than in a population of frequently flying employees of international organizations. The incidence rate did not increase with number of flight hours per year.
Conclusion: This study found that the risk of VTE is not increased amongst airline pilots.
Comment: While this finding at first seems surprising, as airline travel is a known risk factor for VTE, the authors list several reasons why such a low rate of VTE in their airline pilots may have been found: (a) pilots are typically quite healthy (and more healthy than the general population), (b) pilots are probably less immobilized and have less cramped seating conditions than passengers, (c) pilots who were sent the questionnaire may have been reluctant to confirm that they had had a VTE for fear of professional consequences. Nevertheless, it seems like a fair conclusion that the risk of VTE in commercial pilots is low.
- Kuipers S et al. The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots. J Thromb Haemost 2014, Jun 9.
- Cannegieter SC et al. Travel-related venous thrombosis: results from a large population-based case control study (MEGA study). PLoS Med. 2006;3:e307.
- Chandra D et al. Meta-analysis: travel and risk for venous thromboembolism. Ann Intern Med 2009;151:180-90.
Stephan Moll, MD writes… Women are at increased risk for blood clots (DVT, PE, stroke and heart attacks) during pregnancy and in the weeks after delivery. If the risk is high enough, then preventive blood thinners (anticoagulants) are recommended, such as in a woman with a history of a previous blood clot. Guidelines exist as to which woman should be considered for blood thinners (ACOG 2012 guideline; ref 1).
The period after delivery is a particularly high-risk period for forming blood clots. It has typically been defined as being the 6 weeks after giving birth. Therefore, if blood thinners are chosen after delivery, they are classically given for 6 weeks. A study recently published in the New England Journal of Medicine (ref 2) examined whether the risk for blood clots is increased only for 6 weeks postpartum or whether the risk persists beyond the first 6 weeks. Read the rest of this entry »
Dr. Stephan Moll writes… Skyla® is a new intrauterine device (IUD) birth control option, approved in February 2013 by the FDA. Skyla® is like a small version of the Mirena® IUD; it releases low doses of the hormone progestin to help the IUD prevent pregnancy. It has the following features: Read the rest of this entry »
Patients with cancer are at increased risk for developing blood clots. There are several reasons for this: (a) Some cancers produce substances that activate the clotting system; (b) some chemotherapy drugs used to treat cancer can increase clotting risk; (c) some cancers, particularly breast cancer, is treated with hormonal therapy (Tamoxifen) that increase the risk for clots; (d) some patients have catheters in their veins (PICC, port, power-port, central venous lines) and these may narrow the blood vessel and, thus, increase the risk for clots. In addition, the usual risk factors – major surgery, hospitalization, immobility, overweight, hormones and inherited and acquired clotting disorders increase the risk further.
If you have cancer and are diagnosed with a blood clot, your initial treatment will likely be intravenous heparin or injection into the fat tissue of low molecular weight heparin (LMWH). The names of the low-molecular weight heparins are enoxaparin/Lovenox®, dalteparin/Fragmin®, or tinzaparin/Innohep®. While some patients with cancer and DVT or PE get treated with warfarin, LMWH is typically preferred as in many patients it is more effective than warfarin. The length of blood thinners treatment is typically at least 3 months. If the cancer is still active at that time or the patient is still receiving chemotherapy or radiation therapy, the blood thinners are often continued. They are stopped once (a) the cancer is cured or in remission, and (b) the chemotherapy or radiation therapy is completed.
Cancer patients may develop low blood platelet counts due to chemotherapy. During those times patients are at increased risk for bleeding and the blood thinner maybe temporarily reduced in dose or stopped.
There are things you can do to be proactive:
1. Talk with your doctor
Discuss with your doctor your risk of developing a blood clot (deep vein thrombosis and pulmonary embolism). Ask whether you would benefit from preventive treatment.
2. Know the symptoms of a clot
Be aware of the signs and symptoms of a blood clot. Contact your physician right away if you suspect a clot. Don’t delay.
Ask questions, share information and connect with other patients on Clot Connect’s support forum.
Last updated: July 17, 2012
Dr. Anjali Sharathkumar, Chicago, writes…
Can children be treated with blood thinners?
Yes. Children can develop blood clots and require treatment with blood thinner. Additionally, Read the rest of this entry »
Stephan Moll, MD writes… Klippel-Trenaunay Syndrome (KTS) is a rare disorder people are born with. Some individuals with KTS develop blood clots in legs, arms or pelvis (deep vein thrombosis = DVT) or in the lung (pulmonary embolism = PE) Read the rest of this entry »