Any doctors here? Dad has a blood clot in his femoral artery

[Jared at Pelican Parts]

Long story short, my dad's leg started swelling up pretty bad the other day and they found a 4 inch long blood clot in his femoral artery. He's 49, cholesterol, blood pressure and overal health are good. He was told that these things just happen from time to time. Getting him to go to the doctor was a feat in itself.

I guess Im just wondering if this is anything I should be concerned about. They gave him syringes of some sort of anti-coagulant, and he has to take them every 12 hours, plus go to the doctor every day for the next 6 days for blood work.

He's kind of an ornery bastard, hence why I need to convince him it may or may not be serious. Case in point, after breaking his lower pelvis in half while racing old timer's moto-x, docs told him he'd need a lower body cast. He simply took a belt and cranked it around his lower waist to hold it tight. He's starting to get older and I dont want to see him having a stroke or worse..

Can any doctors or anyone who has experience with this weigh in?

[Nathans_Dad]

First off your dad has a clot in his vein, not the artery. Arterial clots block off circulation, venous clots cause swelling.

He is on a medication called Lovenox which is a type of heparin (a blood thinner). The idea is to try and keep the clot from getting bigger and keep it from breaking apart. If it breaks apart pieces can travel to the lungs and cause problems. He likely is being started on Coumadin as well which is an oral blood thinner. Once the coumadin has thinned his blood enough he can come off the lovenox. Most doctors would recommend 3-6 months of coumadin therapy for a blood clot. Sometimes people need to be on coumadin for life if they are determined to have something wrong that gives them a propensity to form clots.

One thing you might ask him is what he was doing in the few days or weeks before his leg began swelling. Things that can cause blood clots are things like long car trips, flights overseas, anything that makes you immobile for an extended period of time. If he didn't have any of these things, I would get him in to an internist to look for some sort of clotting problem to make sure this won't happen again. Hope that helps.

[Moses]

Blood clots don't "just happen". There are three causes, none of them good.

1) Increased coagulation. ( Smoking, medications, inherited blood clotting disorders)

2) Blood not moving well. (Vein obstruction, compression, or immobility like sitting motionless on an airplane all day.)

3) Damage to the blood vessel wall (Scarred or torn, damaged vessels have rough edges that allow tiny clots to attach to the walls where they grow.)

Dad needs to find out why the clot happened. It may be due to his old pelvic fracture. Clots are serious stuff. Even after this one resolves, he may need long-term therapy.

[Joeaksa]

Lost two friends to blood clots, both in their late 40's. Rick's comments about what he was doing is right on. We used to see a lot of them on people who did not move much or on long haul flights. I flew medivac for years and picked up people suffering from the same thing often.

If he starts to act funny or feel different, call 911 now. Brief your Mom about it and tell her its better to be pro-active and have him pissed at everyone than lose him.

Joe A

[12own911]

Warning Signs if a Stroke:

*Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

*Sudden confusion, trouble speaking or understanding

*Sudden trouble seeing in one or both eyes

*Sudden trouble walking, dizziness, loss of balance or coordination

*Sudden severe headache with no known cause

*American Stroke Association

[Nathans_Dad]

For the record, a venous clot cannot cause a stroke unless he has a hole in the septum of his heart.

Clots will get stuck at the first small vessels that they come to. In the case of veins, that is in the lungs. Strokes caused by clots are from clots in the left atrium, aorta or carotid arteries.

[Jared at Pelican Parts]

He recently got back from Australia visiting family, so I guess that has something to do with it. He had said that he felt like he had pulled a muscle in his leg. Lovenox is indeed what he is on. He's also been given Vicodin for the pain (he's hurting bad) They did an ultrasound, and the internist stopped right before his knee saying that he would need to be hospitalized, however the attending MD said he could be treated as an outpatient, provided he comes back everyday for the next 6 days.

Thanks for clearing that up about the arteries. (although they did tell him it was the artery?) Makes sense though, if he was losing circulation, wouldnt there be discoloration and or numbness? Still a bit worried. He's at the doctor's right now

They dont have him on Coumadin though. Rick, are you an MD?

[singpilot]

Jared, sorry to hear about your Dad. Especially if it is a DeepVeinThrombosis from the flight to Oz.

We tell all of our crews to get up and walk around hourly at a minumum.

[Nathans_Dad]

Yes I am an MD specializing in Internal Medicine.

And the flight to or back from Australia was probably what did it.

Yes, with arterial thrombus there should be discoloration of the limb, usually a bluish mottled appearance. I seriously doubt he has an arterial clot.

[Jared at Pelican Parts]

Rick, thanks a bunch..

[Nathans_Dad]

No problem bro, hope he feels better!

[Jared at Pelican Parts]

Originally posted by Nathans_Dad
No problem bro, hope he feels better!

One last question, is this something that may affect me, being in my 20's? I realize health and lifestyle, etc.. but is it something that mainly affects older people?

[Joeaksa]

Jared,

Its now to the point where we, flight crew of all ages, are being told that on long haul flights to get up and walk around. The DVT issue is getting worse and worse on these 10+ hour flights that we are seeing more and more problems.

Do not sit around and do nothing for long periods of time anyway. Move, walk, stoop and get things moving around in your body. 49 years old is not "old people" as I hope you will find out someday. One of my friends was 48 when he died from the very same thing your Father has. The sad thing is that it did not need to happen...

JoeA

[Jared at Pelican Parts]

Joe, I wasnt stating that 49 is old. Hell, my dad looks like he's thirty.

Merely stating that hes older than me =) No offense intended. If genetics are any indication, My dad and I can expect to be alive well into our 90's

[pwd72s]

I find it interesting that flight crews are told to get up and walk around....but not the passengers????

[Joeaksa]

Its easier for one of the pilots to get up and walk around than 300 pax doing the same. As well, if one of the pax has a medical problem, we will land and deal with it. If one of the two or three pilots has a health problem while flying, life gets much more interesting. Believe me, you want all of the pilots up front in good health at least until the landing!

I have seen recomendations for the pax to move around on the longer flights, just not sure that its been spread around.

Jared, was just kidding with you. It used to be that 50 was "middle age" but now that has been moved to 60 or so because of the activity level of the current generation.

Keep yourself in good shape and try to stay up with your Dad!

Joe A

[Nathans_Dad]

Jared: It would seem like your dad had a risk factor for DVT which is the flight from Australia. If he had developed the clot without any risk factors then a workup for a clotting disorder would be indicated. As it is, they probably will not work him up since he had a trans-Pacific flight. As for you, it probably will never affect you, just remember to get up and stretch your legs every hour or so while on an airplane. That's standard advice for anyone on a long plane trip.

[Moses]

Originally posted by Nathans_Dad
Jared: It would seem like your dad had a risk factor for DVT which is the flight from Australia. If he had developed the clot without any risk factors then a workup for a clotting disorder would be indicated. As it is, they probably will not work him up since he had a trans-Pacific flight. As for you, it probably will never affect you, just remember to get up and stretch your legs every hour or so while on an airplane. That's standard advice for anyone on a long plane trip.

I always find that interesting. I wonder what the frequency of DVT is in trans-Pacific flights? One in a thousand? Ten thousand? Why him? I'd work it up. Why wait till he gets a pulmonary embolus to find out he has a protein S deficiency? I'm not suggesting it's likely that he has a coagulopathy, just saying if it's my dad, it gets worked up.

[Nathans_Dad]

Well, Moses, that isn't standard of care. If there is a identifiable risk factor then a secondary workup is not required. I'm not saying that I would not work him up for secondary causes, but I'm not his doctor and I haven't seen the patient so I would hate to speak for another physician.

[Nathans_Dad]

Just out of curiousity I tried to look up the incident of DVT associated with long travel. Here is one site that summarizes some of the studies. The true incidence is still being debated:

"Of 1851 patients, 235 had travelled for more than 4 hours in the 8 weeks preceding the VTE. Travelling for more than 4 hours in any form of transport was found to increase the risk of VTE three fold (95%CI 2.0-4.2)1. The risk of flying was similar to the risk of travelling by car, train or bus."

http://www.dft.gov.uk/stellent/groups/dft_mobility/documents/page/dft_mobility_610897.hcsp

I saw several studies that showed incidences up to 4% on flights of 12 hours or more, although those were found by ultrasound and certainly not all would be clinically important. I'm not sure what the flight time is to Australia though.