Ask a doctor on the topic of Internal medicine

Thrombosis prognosis

November 18, 2015 | 20,00 EUR | answered by Dr. med. Ive Dr. Schaaf

Dear Dr. Schaaf,

I have been following your contributions in forums on the topic of thrombosis and also your website Thrombose-Hilfe, and I am glad to see you are caring for those affected.

Now I am reaching out to you as I also have some questions. I am currently undergoing treatment for a thrombosis (1st stage, lower leg with a small piece in the popliteal area). After each doctor's appointment, more questions arise for me.

A brief overview of my story:
The thrombosis followed a sprained ligament in my foot on the left leg. I wore a tight orthosis for an extended period, rested a lot, and then went back to work in the office with my legs crossed under the table. Then my lower leg started to swell. Additionally, I drank a lot of coffee and unfortunately not enough water. At first, I didn't take it seriously. After a week, following my physiotherapist's advice, I went to the hospital. Diagnosis: DVT 1st stage (tibialis posterior, short segment popliteal, small pulmonary embolism). This was over 6 weeks ago.
This Monday, I had my first important check-up. Results: calf completely clear, remaining thrombi still in the back of the knee, all valves intact, the remaining thrombi are expected to dissolve and by the end of the year, it should be resolved. My doctor mentioned that she rarely sees such a fast recovery after this time.
It is still unclear if I have a coagulation disorder, as I was already taking Xarelto when the first test was conducted, making the results not usable. The first hospital visit was only for thrombosis, then 2 days later again to the hospital with a small pulmonary embolism.

Now to my questions: I read a post where you explain that thromboses of my size heal quite well and without significant consequences. Is this correct? Can the valves still get damaged if the calf is completely clear without any remnants? What consequences can arise in my case? Do I need to wear a compression stocking permanently? Is a coagulation disorder likely if there is a specific cause? I am 33 and should have noticed something earlier, right? There are no known cases of thrombosis in the family, only varicose veins due to pregnancies.

I am active. I am now working part-time, drinking a lot, not smoking, stopped taking the pill, and also lost some weight (but was not overweight to begin with). I wear my stocking up to the groin day and night and take my pills reliably.

I am looking forward to your response.

Thank you for your help.

Warm regards,

Dr. med. Ive Dr. Schaaf

Good evening,

You have read correctly: Your prognosis is really good despite the involvement of the popliteal vein exceeding the finding of a lower leg vein thrombosis. In essence, the popliteal vein extends to the thigh. But especially because everything is resolving so quickly in your case and the valves have shown no damage so far, I am very optimistic.
In general, it is assumed that valves that are currently damaged will remain functional, but I have seen it happen differently before, so I cannot guarantee that to you. However, I am also optimistic that the chances of no lasting valve damage are good.

Are you sure you had a pulmonary embolism?
What tests were done?

Whether you will need to wear a stocking permanently cannot be determined yet, but you will probably be able to do without it permanently or at least largely. However, I would recommend that you wear a stocking permanently during long journeys, high feverish infections, and surgeries, especially with immobilization of the ankle, in the future. This can be a lower leg stocking, which is quite comfortable and easy to put on.

By the way: You no longer need to wear the stocking at night! It's enough during the day.

It is correct to rule out a coagulation disorder as a precaution, but I expect that nothing will come of it. If it does, it is especially important for any potential children. They will need to learn early what risky situations are and how to prevent them.

Is everything clear so far?
If not, please ask.

All the best,

Dr. Schaaf