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Have aggressive clotting disorder, ruptured ovarian cyst. Reason for pain in armpit?

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Practicing since : 2003
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Do I need to seek medical attention right away?I am a 28 year old female with a very aggressive clotting disorder, factor 5 Leiden only 1 gene - however I clots like I have both genes. I currently take 20 milligrams of warfarin to stay in my INR range which is 3.0 to 3.5. My last INR reading was 2 and a half weeks ago and I was at 3.8. I have had too many DVT's to count, severe bilateral PES in October of 2010, and severe hemoperitonium (sp?) bleeding in abdominal cavity in August of 2011 (complications from INR of 5.7 and an ovarian cyst that ruptured) I remember having referred pain to my collarbone from the hemorrhaging incident. It was that small detail in the emergency room that completely changed the physicians plans for diagnostic testing and ended up finding the hemorrhage in time to get me too surgery before I went into shock. Now anytime I breathe in deeply weather it's to sneeze or cough or yon or just a XXXXXXX breath by itself I am getting a very sharp stabbing pains in my armpit on the left side only. I am worried because this is the side that the heart is on... Do I have anything to be anxious about or am I just getting myself worked up over nothing because of my past medical history? Could this be another blood clot passing through my heart or my lungs?
Posted Tue, 19 Mar 2013 in Asthma and Allergy
Answered by Dr. Gyanshankar Mishra 1 hour later
Thanks for posting the quwery on XXXXXXX After going through the query, I would like to comment the following:

1. You seem to be suffering from recurrent dvt (factor 5 associated). Target INR of 3 to 3.5 is absolutely correct.

2. Your current INR of 3.8 is a bit on the higher side and dose of warfarin needs to be titrated accordingly.

3. You are currently having left sided axillary chest pain. You need to get yourself investigated for this. Atleast a chest xray is required to rule out left pleural effusion. If a left pleural effusion is found out then its cause needs to investigated and a CT Pulmonary angiography may be required. Considering your INR and clinical presentation , it's unlikey to be a clot in the lungs or heart but that needs to be investigated as outlined above.

4. You need to get yourself evaluated on the above lines in consultation with a pulmonologist as soon as possible.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.


Dr. Gyanshankar Mishra
Consultant Pulmonologist
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