Questions about thrombosis - thrombosis and then?
December 14, 2014 | 15,00 EUR | answered by Dr. med. Ive Dr. Schaaf
Hello Dr. Schaaf,
First of all, thank you very much for your service.
Two weeks ago on Friday, I had a muscle bundle tear in my left calf, so I couldn't be very active. Last Monday, I was quite weak and had pain in my calf while standing and sitting over the weekend. As a result, I went to see my general practitioner. He diagnosed a first-floor thrombosis and sent me to the hospital with suspicion of a pulmonary embolism.
At the hospital, another ultrasound was done and the thrombosis was confirmed. Since then, I have been receiving 2 injections daily, wearing a stocking, and have been on Marcumar for 5 days now. I will most likely be discharged on Tuesday.
Now, my questions (unfortunately, they are not being answered here in Munich):
1. The doctors are refusing a follow-up ultrasound due to the risk of something dislodging...
2. I am naturally worried about whether a pulmonary embolism can still occur and if the danger decreases day by day. Is there a guideline that I can refer to?
3. There was no check-up of the lungs. Is this normal?
A bit about me: I am 40 years old and predominantly sit for work.
I look forward to your response.
Best regards from Munich,
Markus
Good evening,
First of all: It would be good to know where the thrombosis is located - in the lower leg, thigh? This is of relatively great importance for further treatment and prognosis.
Regarding your current treatment:
With a 1-level thrombosis, there is no need to be hospitalized and it is better not to be, because in addition to compression and anticoagulation (blood thinning medications), you need movement, which you will have more of outside rather than in the hospital. I am surprised that you are being kept in the hospital for several days, I do not see the justification for it.
The administration of two injections per day should be correct (depending on the medication and dosage).
Taking Marcumar is now only recommended in cases where modern anticoagulants (Xarelto, Pradaxa, Eliquis) are not tolerated. They work immediately (Marcumar has a delayed effect) and at full effect from the first tablet (Marcumar takes days to work, the adjustment is lengthy and difficult).
Regarding question 1:
In my opinion, a follow-up ultrasound is sensible, although - with a good clinical course - not necessarily required, but certainly not dangerous.
Regarding question 2:
No, there is no set standard, but you are right, the risk decreases day by day and is particularly low with WELL-ADJUSTED anticoagulation. However, not with poorly adjusted anticoagulation, which unfortunately often occurs at the beginning of treatment with Marcumar. The risk is highest in the first two weeks after the onset of thrombosis. The onset is usually not noticed, by the time of diagnosis, a few days have usually passed, as in your case.
Regarding question 3:
No, it does not help. It is only done in case of deterioration, not with a normal course (=slow improvement), especially because of the exposure to radiation.
Best regards,
Dr. Ive Schaaf
Any more questions? Always happy to help.
