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What does severe vericose veins and blood clot on legs indicate?

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Practicing since : 1999
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My 35 year-old daughter who has six children has developed severe vericose veins and currently still has a blood clot in her leg. She was prescribed Lovanox during the last pregnancy and is now taking aspirin. My first question is, how XXXXXXX would it be for her to go through another pregnancy?
Posted Mon, 17 Feb 2014 in Hypertension and Heart Disease
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer: Hello, I would be happy to help... Detailed Answer: When you say that she has a blood clot in her leg, is this a DEEP clot? These are different than the superficial varicosities. Also, why did they prescribe lovenox last pregnancy and not during the ones before? What changed? I need more history before I can give you the best answer possible!
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Follow-up: What does severe vericose veins and blood clot on legs indicate? 2 hours later
It is a deep clot in her leg. During the last pregnancy is when the clot developed and she had a subsequent embolism in her lung. She was hospitalized then and started the lovenox for the rest of the pregnancy. We are very concerned that another pregnancy would be very XXXXXXX and put her at risk for a very serious embolism and further damage to the circulation in her legs. She has been led to believe taking the lovenox again would protect her. She has seen a hematologist who has recommended stripping the damaged veins. He also told her that hers was the worst case he had seen. She is wearing compression hose and taking 81mg aspirin daily. She is healthy otherwise.
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer: Thank you for the followup... Detailed Answer: This is an incredible story, BUT it is not so unusual for women to have a predisposition to blood clotting. In your daughters case, the following workup must be completed: 1. She needs a visit with a high-risk OB 2. She needs a full workup to determine her risk of future clotting 3. The labs for #2 would include: Testing for predisposition to clotting: a. labs related to antiphospholipid antibody syndrome (APAS) b. labs related to thrombophilia (genes that when abnormal, make clotting more likely) The importance of this workup is that if there is no underlying risk (besides being pregnant) then a future pregnancy would probably be relatively safe on a "prophylactic" dose of lovenox = single dose daily. If there was an increased risk besides just being pregnant, then she would need to be on a "therapeutic dose" of Lovenox = twice daily dosing. We deal with women with such stories frequently. The Hematologist should have done labwork like I described. The recommendation of surgery on her veins DEFINITELY deserves a second opinion, as this is not a typical recommendation. Perhaps a vascular surgeon should also be consulted. Let me know if this helps!
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