Archive for the ‘Special situations’ Category
Stephan Moll, MD writes… Some patients may only have mild symptoms when diagnosed with a deep vein thrombosis (DVT) or pulmonary embolism (PE) and may feel normal again within a few days after initiation of blood thinners. Patients with more extensive clots and more pronounced symptoms may take several weeks to get back to normal Read the rest of this entry »
Dr. Stephan Moll writes…..
When a young person is diagnosed with extensive pelvic DVT or a clot in the big vein in the abdomen, the inferior vena cava (IVC), it is worthwhile to ask whether that person has some congenital abnormality of the IVC, such as a congenital absence or narrowing of the IVC Read the rest of this entry »
Birth control pills, patches and rings typically contain an estrogen and a progestin component. It has long been known that estrogen-containing birth control preparations (pill, patch, ring) increase the risk for blood clots (DVT, PE). This risk is partially due to the estrogen. However, part of the risk for clots is also due to the type of progestin in these preparations. Read the rest of this entry »
A new guideline about the prevention, diagnosis, and treatment of DVT and PE associated with pregnancy was published today by ACOG (American College of Obstetricians and Gynecologists) in its respected series of Practice Bulletins. The bulletin also takes detailed reference to prevention of blood clots in pregnant women with thrombophilia. Read the rest of this entry »
The CDC today published recommendations on use of birth control methods for non-breast feeding women after child birth (full text is here). The key recommendations are as follows: Read the rest of this entry »
How common is pregnancy loss? What are the causes?
Pregnancy loss (= miscarriage) in the general population is common. Most losses occur in the first trimester. As many as 5 % of women have 2 or more early losses; 1-2 % have 3 or more early losses [ref 1]. Well established risk factors for pregnancy loss are: (a) advanced age of the mother, (b) anatomic abnormalities of the uterus (such as fibroids), (c) chromosome abnormalities of fetus, the mother or the father, (d) underlying diseases of the mother (endocrine, immunologic), (e) maternal hormonal unbalances. The acquired clotting disorder called “antiphospholipid antibody syndrome” is also a risk factor for pregnancy loss. The role of inherited clotting disorders (= thrombophilias) contributing to pregnancy loss is less clear. Read the rest of this entry »
CT scans and MRI scans are often done in medicine, for a variety of reasons. Every so often such a scan will detect a blood clot in a patient who has no symptoms from the clot. This is referred to as an “incidental VTE” (VTE = venous thromboembolism, i.e. clot in a vein) or “asymptomatic VTE”. Such a clot may be a DVT in the pelvis or leg, in the major abdominal vein (vena cava), or in one of the intestinal veins (portal vein, splenic vein, mesenteric vein, or renal vein). When such an incidental, asymptomatic VTE is discovered, the question arises whether the patient should be treated with “blood thinners” or not. Read the rest of this entry »
Many people think of blood clots as a problem occurring in elderly people, but not in young and apparently healthy individuals. While it is true that clots occur more commonly in the elderly and in non-athletic overweight individuals, they can, nevertheless, happen in young, normal weight, and athletic people. Read the rest of this entry »
Testosterone Replacement Therapy
Replacement therapy with low doses of testosterone does not adversely affect blood coagulation status [ref 1] and does not appear to increase the risk of venous or arterial blood clots. Thrombosis is not listed as a potential side effect in a commly used drug compendium (Micromedex). Furthermore, the 2006 “Clinical Practice Guideline” from the Endocrine Society also does not list blood clots as a side effect of testosterone replacement therapy, or a previous history of blood clots as a reason not to give testosterone replacement therapy [ref 2]. However, the Androgel® package insert (prescribing information) lists “blood clots in the legs” as a potential side effect Read the rest of this entry »
It is well known that combination contraceptives (containing estrogens AND progestins) increase the risk for blood clots (venous thromboembolism = VTE). Relatively few data, however, have been published on progestin-only contraceptives, so that until recently it has not been clear whether they increase the risk for VTE or not. Read the rest of this entry »