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Suggest Treatment For Swelling In Leg Despite Having Coumadin For Blood Clots

Posted on Thu, 22 Jan 2015

Question: I have blood clots in my leg (confirmed by Doppler) which are being treated for 2 weeks with Coumadin. INR level is good: 2.6. Notwithstanding the treatment, the swelling in the leg (From toes to upper leg) has increased and bottom half of the leg is hard. Is this an indication that something else needs to be done?
XXXXXX

Answered by Dr. Jyothi B L (59 minutes later)

Brief Answer:
Intravenous anti-coagulation possibly necessary.

Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.

Based on your query, my opinion is as follows:

1. The increasing swelling points towards still a persistent blood clot (thrombus) in the deep veins.

2. Warfarin therapy, at present appears to be not helping much. It is preventing further thrombus from forming, however, it is not helping for now. Low molecular weight heparin could be helpful, if not started earlier. Warfarin can be restarted after 5-10 days of low molecular weight heparin.

3. Meet your doctor again and get a repeat doppler done. The swelling should reduce. Thrombolysis needs to be done. Intravenous anti-coagulation is needed. Discuss with your doctor.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Jyothi B L (1 hour later)

Thank you. I will follow up your suggestions
XXXXXXX

Answered by Dr. Jyothi B L (5 hours later)

Brief Answer:
Welcome...

Detailed Answer:
Hi XXXXXXX,
Thanks for replying.

Do followup with your doctor. Continued anti-coagulation is necessary for life to prevent thrombus formation in future. Visit your doctor and plan appropriate treatment.

Hope it helps.
Any further queries, happy to help again.

If you do not have any further queries, you can close the discussion and rate the answer.

Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Jyothi B L (16 hours later)

The in-house does not want to take another Doppler not use heparin at this time. He wants to use an increased dosage of Coumadin. I am measuring whether the leg swelling is increasing. If it is, I will go to the hospital for thrombolysis treatment. If swelling stays the same, what sould I do?

Answered by Dr. Jyothi B L (1 hour later)

Brief Answer:
Increased Coumadin could help.

Detailed Answer:
Hi,
Thanks for asking again.

Yes, increased dosage of coumadin could help. It is normally second line therapy, when not hospitalized.

If the swelling is same, means some amount of blockage is clearing. Better would be, for it to reduce. You can check the amount of swelling by pressing with finger. Usually some amount of pit forms, when pressed.
If its increasing, not good. Better to go for thrombolysis treatment. Cannot advise limb elevation or excessive movement as it can dislodge thrombus. Watch out for any breathlessness. Needs to be viewed seriously.

If swelling stays same, not to worry. Only if any blackening anywhere in the distal area (toes, etc), or ulceration (wound formation) or breathlessness, then go to hospital. Until then, take coumadin and maintain INR as usual.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

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Above answer was peer-reviewed by : Dr. Raju A.T