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Had a c-section. Got admitted for blood clot in legs. What treatment should be done?

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my co-sis aged 34 delivered 0n 19th was a c-section. since past one week she is admitted for a blood clot in her legs. after the 2nd scan the clot has got bigger from 7 to 9 cm. they are injecting some medicine for it to dissolve and not enter the lungs. she stays in it safe to get her to KIMS hospital in trivandrum. since its quite urgent plsa suggest on how to proceed with this. are there any specialists on this... she herself is a physiotherapist doctor. so she is feeling the seriousness of the issue and losing hope. moreover she conceived after medications for almost a year. she is very thin and short. not so healthy looking. she had diabetis during preg. please help as soon as possible. we need to take some decision today, if we need to move her to KIMS or not.
Posted Sun, 31 Mar 2013 in Medicines and Side Effects
Answered by Dr. Prasad Akole 58 minutes later
Dear XXXXXXX, welcome and thanks for entrusting your query here at HCM!
I am Dr. Prasad Akole (Critical Care Expert- 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
Good Luck! Thank you!!
Above answer was peer-reviewed by
Follow-up: Had a c-section. Got admitted for blood clot in legs. What treatment should be done? 35 minutes later
thanks for your reply.

she has undergone a ecg and there isno problem on this. She is also not having any breathing problem now. initially she was in ICU for 3 days. now she dont have breathing problem/ normal BP.

she is injected with lmwx (0.4ml) twice daily along with some antibiotics. and acetone 5mg tablet oncein 6 hours.

i am not sure how good the team is. but KIMS hospital in Trivandrum has got specialists in all fields. since she had a c-section, can a surgery be done to remove this?

there will be a scan today as well. if there is any progress, they are planning to continue with the medication. is this a correct option? or once this course of medicine is finished should we anyway take her to KIMS?

is there any need to consult a OBGY specialist? this issue comes under which stream/field?

Answered by Dr. Prasad Akole 29 minutes later
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.
Above answer was peer-reviewed by
Follow-up: Had a c-section. Got admitted for blood clot in legs. What treatment should be done? 1 hour later
Thanks for your reply.

as of now, I have asked her to do an echo, the INR is 1.87 it seems. they say she would be discharged once it reaches 2.

she is not bleeding due to Caesarean. so looks like she is on the better side. is there anything else i had to keep a check on?

hope she would recover soon. tomorrow there is a scan, after which we will know if the clot has got reduced in size. i will update on her process then.

also, though you said surgery is not required, is laser surgery possible?. why surgery is not preferable?

now i am feeling bit relieved from stress, after chatting with you. thanks for that.
Answered by Dr. Prasad Akole 5 hours later

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.

Above answer was peer-reviewed by
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