Dear XXXXXXX, welcome and thanks for entrusting your query here at HCM!
I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.

A well asked query!
I read that your sister has post-partum XXXXXXX Vein Thrombosis (DVT) after a precious pregnancy.
It is equally true that sometimes it can be life-threatening due to risk of Pulmonary Embolism (PE- blood clot getting trapped in major lung blood vessels).

She should receive urgent evaluation and treatment at a capable centre, which has 2 D echo and a good ICU. Any good physician or intensivist can manage it along with the obstretic team.


She should undergo a 2D echo to know if the right side of the heart is pressure overloaded from PE or failing and a CT pulmonary angiograpgy (CT scan of lung vessels) to see if there is a clot already there.
Such patients may have low BP, breathlessness due to oxygenation failure and risk of sudden death.

If she is unstable, has shock (low BP), needs ventilation or right heart is badly affected, she may need thrombolysis (Clot dissolving medicines like tPA). Of course, there is a risk of bleeding after a caesar and may not be fir for it.
Other option is anticoagulation (clot preventing medicines) which again are risky after a C-section.

This is a usual tricky situation and the treating obstetric team should give opinion if it is safe… most probably it is not. Heparin may be allowed under supervision and I think that is what they must be doing.

She must be BP wise and oxygenation wise stable and 2 D echo and CT pulmonary angio must be seen before deciding to transport her anywhere, at least in the initial 24 hours.
It is indeed a crucial decision and you must talk with the entire treating team if they can manage there only and decide shifting after 24-48 hours of stabilization.

If the centre is not a large one or has no such facilities and a good ICU, she may be shifted in a cardiac ambulance with good crew.

According to me, the first option is better if the team is comfortable. She should be watched for lowering BP, oxygenation, chest pain, breathlessness and bleeding.

I wish her good health!!


I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Please ask for any clarifications before closing and rating this answer.

Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
Good Luck! Thank you!!

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Thanks for the update XXXXXXX.

It is heartening to read that she is stable and is under appropriate anticoagulation cover.
LMWH along with oral anticoagulant (Acitrom…is it you meant?) is appropriate after a major surgery like C-section in the recent past.
Even if she is stable, has any 2D echo and CTPA done along with a lower limb Doppler to see if there is any lung clot? An ECG alone is not enough. ECG can be normal with XXXXXXX embolism. It is not a definitive test here.

Anyway, from this update, I feel she is stable to be shifted, if needed. A CT pulmonary angio gives us a clearer picture of the risk.

If this is not possible where she is, I think you can transfer her to a bigger center with multi-specialty back up.
Obstetric opinion is needed to see she is not bleeding at the operated area. This risk will lower as day’s progress. She is fairly away from the initial post-operative period and little worry.

In addition, I am sure they are checking PTTK and INR to ensure the blood thinners are well controlled at 2-2.5 times the normal value.

There is no surgery needed at this time to remove the clot. She needs ling term oral anticoagulation with VKA (Vitamin K Antagonists like Acitrom), which she is on. LMWX will be stopped once INR is 2-2.5 times normal. The leg will be immobilized until she is well anticoagulated. Ad movements can dislodge a clot to cause serious embolism.

It needs a multi-specialty approach with a physician to manage long term anticoagulation, an obstetrician to follow up for the wounds and bleed, cardiologist for the echo evaluation, radiology for CT angio and dopplers and a pediatrician to advise on breast feeding the baby while mother is on oral VKA (blood thinners).

She is under appropriate treatment. Just ask the doctors about the echo and angio part, if you are not aware about it.

I hope this helps. Keep me posted on her progress.
Take care.

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Dear XXXXXXX,

Laser surgery does not help this kind of clot because it is due to hypercoagulability of blood during pregnancy (which normally occurs). Some ladies get brain vein clotting.

So surgery does not help. Bood thinning does.

She has to meticulously take the advised blood thinner, do regular INR tests, follow strict diet to avoid variations in blood thinner levels due to various food and drug interactions.

Rarely people have predisposing factors like enzyme/ factor deficiencies or high homocysteine which may promote venous thrombosis.
Her condition is most likely pregnancy and hormone related.

Hope that answers your question precisely.
Well then. You can take her to your nearby hospital then....So happy?

I would be glad if you leave your feedback/ review of this answer before you close the query. It helps us answer better next time.

Thanks.

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