Aspirin for DVT?

[chbare]

The pathophysiology is complex but can be distilled into a single concept. Venous clots are composed mostly of fibrin while platelets do not contribute much to the venous clot. This is why anti platelet aments such as aspirin and platelet glycoprotein inhibitors are not commonly used to treat DVTs. This also explains why agent such as warfarin, heparin and low molecular weight heparin are commonly used.

A new study has demonstrated that aspirin does appear to prevent dvt formation in some patients, but the results have yet to be replicated in other studies to my knowledge.

Edit: "Complex."

Edited July 15, 2012 by chbare

[DwayneEMTP]

Ahh...I see. So I may not have been completely off in the ditch, probably am, but possibly not, for taking ASA prior to international travel, but it really made no sense for the suspected DVT.

I can see that now...

Thanks guys..that's cool as hell....

[mobey]

I am not refreshing on the clotting cascade, but basically platelet adhesion is the first step in forming the clot. Once the clot is passed that initial point, platelet adhesion is less important. Thrombin activating fibrinogen to form Fibrin then becomes a more important factor in forming a solid clot.

True enough, platelets will stick to this now solid clot, and continue the cycle..... but in this case, inhibiting that aggrigation is not going to prevent the clot from continuing to grow through the: Thrombin - Fibrinogen - Fibrin mechanism.

Furthermore, and possibly more significantly, if platelet adhesion is stopped and the clot weakens, one would expect it to possibly break up and continue in the circulation till it becomes a Pulmonary embolism.

Now you got a sore leg, short of breath, and a pneumonia..... and you have to hear me tell you "told you so".

Another thought: Ever had your INR checked?

[bizar.one]

my initial thought in this matter... well it seems like you might be at risk of a DVT... although due to your history of traveling and discomfort in the calf area are all text book signs and symptoms of DVTs... minus the swelling and the warm or hot to the touch to the affected area... another thing...why are you taking that much ASA in a day... my concern would be for you to become acidotic and cause a change in your PH system. that can also relate to maybe the signs and symptoms of your cramps, which also may explain the bruise on the side of the calf. The whole "pop" that you felt with the relief of symptoms.. that would definately sound more muscular than all...

So in summary

i would say... watch how much ASA you are ingesting a day, u might develop an ulcer..

second of all... how is your dietary intake... u do mention keeping hydrated... being in a third world country an all.

check yourself for any DVT's

[DwayneEMTP]

Thanks Mobes...

The issue was resolved that night. By the time of the post I'd been symptom free for about 24hrs or so. And thanks for the review. I'd learned that, but forgotten it, but I recognize it and it makes sense upon review. I KNOW! I could have Googled it, but it wasn't the answer I was looking for so much as the conversation and the thoughts, thought I'm grateful to have an answer.

If I've ever had my INR checked it would have been during one of my routine job screening blood draws, so I'm guessing not. I don't think that I normally have any clotting issues. I'm usually really careful about getting up and moving my muscles during the long flights, and monitoring my urine output for hydration status. But on this trip I slept for 8 hrs or more straight, which I've never done before, and the night before had been drinking the worlds nastiest tequila with some folks in the poorer part of town while I was stuck in Dallas. The history combined with the symptoms is what led me down that road.

Bizar, good points all. That's not a habit of mine, to take so much ASA, it was only my misguided attempt to stop the growth of the clot if in fact a clot it was. The dosage came from nothing more intelligent than my having 324mg/tab on hand and guessing that I wanted more than a 'standard' dose. Because I thought it would be better? Nah...I had no intelligent reason for it, it was just the only tool that I thought that I had and I wanted to quash this thing the best that I could. I can see why a dose of that level might cause acidosis, but it was for two days only.

[DFIB]

Great Gobs Of Galloping Gorilla Grunt! Your original post is scary even to read! I can only imagine how spooky it was to live it!

I really don't have anything intelligent to ad to what everyone else has already posted. I would mention a thought that being a remote medic you should be careful not to fall into the mentality that you somehow have to hold yourself to the same level of care that the indigenous patients can receive or afford. It is sad that they cannot receive the same level of care that you can, but that is no reason for you to think that you have to constrain your healthcare to the same limitations that they have.

Dwayne, buddy, Get the care you need and deserve, find out if you need to be on anticoags or clot busters or whichever is the best and most appropriate care you can get off your butt and take care of yourself! I mean that in the kindest and fraternal way. Love you brother but you worry me sometimes.

[DwayneEMTP]

Thanks DFIB, but the treatment decision wasn't completely altruistic.

It's kind of weird. The company I work for provides medical people on the ground, but their main job is as an insurer, kind of. Making arrangements, guaranteeing payment, setting up escorts and transportation. When we have someone at the mine that needs to be seen in the hospital there is this huge human cascade of events that takes place, it's really a beautiful thing.

But when they though that I might have the DVT, it doesn't work exactly that way. I would have had to arrange transportation, which more than likely would have meant taking the crew bus, so an 8 hr drive instead of 5. If I was really lucky I would have been seen the day after I'd checked into the ER, but almost certainly the day after that which means that I would have had to find accommodations for myself in Lae for the two nights.

It would have been difficult to find the accommodations, any that I'm likely to be able to afford would be unsafe for an expat, and those that would be safe are well outside of my ability to afford. Plus, the hospital would have been, according to the best estimates that I could find, probably about K4,000, or about $2,000US.

All of which I would have had to pay and then submit back to my company for review, upon which time they will decide if they felt that there was a true medical necessity for me to go or not, and if all of the money spent was necessary, and whether or not they would pay any of it back per my "insurance."

So my main thought was, "By the time that I can get to the 3rd world medical care, spend most the tiny bit of savings that I've got, all of this will be resolved one way or another anyway. If I start now, it's probably going to be to late before I get to treatment."

So I had three thoughts. "Hopefully I won't die before it becomes emergent, at which time my company is obligated to medicac me to Australia and pay all costs, or hopefully it's not a DVT, Orrrr if it's a DVT hopefully I won't die."

I didn't really see many other options within my single income family budget...Know what I mean?

My biggest problem was that if it was a DVT, I didn't have any idea what to expect for progression. Do they just blow up suddenly? Do they grow, or is it as big as it's going to get? If it is going to grow, how fast will it do so?

I considered resigning my position and just going home, but non only if it worked would that mean another 45hrs of travel before getting to care, but my company would simply have refused to arrange transport so I would have been stuck still.

My guess is that once they considered that it might be a DVT they decided that if they couldn't get me to pay for my own care, then it was cheaper for them to process my dead body than it was to have to try and care for my living one.

It's a crazy world...

So I guess, if this threads not dead now from my bullshit ramblings, maybe we can explore what might have been expected?

Let's assume that the issue I've described was in fact a DVT. What would the expected progression look like over what period of time?

[DFIB]

I can see how complicated the care would be and there is no assurance that the hospital would of had the medication the could have helped you on hand anyway.

I am going to have to read some about the progression of DVTs before continuing. I am very glad the the thread and you my friend are still alive.

Cheers.

[runswithneedles]

glad to hear you didnt feel a pop and a sudden onset of SOB and hemopytsis.

[krumel]

Just by the way: There is a small study in German that showed some chance of "dislodging" a DVT after high dose Aspirin.... I'm currently only online from my notebook but I will post it later.... So be careful next time;)

BTW: Can understand your decision...But be aware: At the point it pops you will be "to late for medevac"... Poplitea DVTs are normally big enough for a deadly PE...