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CD, thanks for looking it up. Maybe hypercoaguability was a factor or maybe 5 days of Plavix before the procedure is better than a loading dose the day of the procedure. Having it for five days pre-procedure fits with the research on intimal hyperplasia and cod liver oil, that for some reason taking cod liver oil (which is an antiplatelet like plavix) the week before a procedure made the biggest impact. (Plavix isn't being prescribed to address intimal hyperplasia but to hopefully limit clotting, so this is extrapolation. The idea is to get the factors in the blood right before the trauma to the veins rather than afterwards.)

If I can keep asking questions, CD, were you having symptoms the night of the procedure or the next morning? I know your doctor caught the flow issues on the ultrasound the next day, but not all doctors order follow-up ultrasounds. If it hadn't been for the follow-up ultrasound, would you have known something was wrong and gone back to the doctor?

Cece wrote:CD, was your first dose of Plavix a loading dose of 300 mg or was it the usual amount?

Dr. Cumming, glad to see you here on TIMS today! I've been meaning to ask in your thread if you've given up lovenox entirely for plavix instead? Is this due to what you'd been saying after ISET, that there wasn't much consensus on what anticoagulation if any?

No right answer...

From listening to Dr Ma'moon Hasan Al-Omari talk in Glasgow, they reported a few acute jugular thrombosis post cutting venoplasty. So, my current strategy is to use lovenox or coumadin in patients that require aggressive (ie cutting balloon/wire) venoplasty.

I have been encouraging others to do lovenox if they can tolerate the injections and the cost. You can transition over to coumadin but it can take awhile to get the dosing right.

Otherwise, an aspirin plavix combo is probably fine.

In the end, it might be shown that none of the above is better then taking nothing. We do not know. But, since the risk of these drugs is low, there is not much downside if you can tolerate them.

Cece wrote:CD, thanks for looking it up. Maybe hypercoaguability was a factor or maybe 5 days of Plavix before the procedure is better than a loading dose the day of the procedure. Having it for five days pre-procedure fits with the research on intimal hyperplasia and cod liver oil, that for some reason taking cod liver oil (which is an antiplatelet like Plavix) the week before a procedure made the biggest impact.

(Plavix isn't being prescribed to address intimal hyperplasia but to hopefully limit clotting, so this is extrapolation. The idea is to get the factors in the blood right before the trauma to the veins rather than afterward.)

If I can keep asking questions, CD, were you having symptoms the night of the procedure or the next morning? I know your doctor caught the flow issues on the ultrasound the next day, but not all doctors order follow-up ultrasounds. If it hadn't been for the follow-up ultrasound, would you have known something was wrong and gone back to the doctor?

First some fyi:
Being a Norski, I grew up on Cod Liver Oil, (yucky) every morning before school, and tons of oily fish for dinners. As a kid I bled easily and had band aids all over my girlie tomboy limbs. I married very early and stopped taking it, my DH still takes it.

If the veins get ballooned with antiplatelet meds, they will bleed more with more chance for thrombosis, IMO. I don't think follow up ultrasounds are that great. I had one after the first procedure two days after.

When I had the second procedure I was so sore, no one was going to press on my neck with an US machine, and they didn't want to. (Whew). They said three months at Dr. Siskin's clinic.

As for the question, did I know I was stenosed? No I could not tell at all. I had the right jug working and the ayzgos working so my collaterals were still there on the left, doing what they do.

I know I had trouble sleeping, staying in a hotel and waiting for the testing so I could finally go home. It was not to be. They set up another Angioplasty for 7am the next morning, so another sleepless night in the hotel. I got two more stents in the left, that is why it was so sore.

My procedure were almost back to back and three stents to get flow.
CD

What an experience, CD. I am not sure what conclusions can be drawn! That follow-up ultrasound caught what was going on for you and, since you didn't feel any symptoms, it would've been missed in a patient whose doctors does not do a day-after follow-up ultrasound.

Cece wrote:What an experience, CD. I am not sure what conclusions can be drawn! That follow-up ultrasound caught what was going on for you and, since you didn't feel any symptoms, it would've been missed in a patient whose doctors does not do a day-after follow-up ultrasound.

Yes, that is true. I probably would have gone home to only find little improvements, not even knowing that I was blocked with clots in the first stent. Who knows, can US the next day or so, cause a clot or blockage??? I don't know.

Maybe it is better just to leave the veins alone and let them heal without pushing on them. It is not life-threatening to have re-stenosis and people can live okay with clots, at least little ones.

Most small blood clots will enter the lung and as long as they are small, and the lungs will dissolve them, I read a paper on Cardio blood clots doing that. It is rare that they go to the brain. Over time the meds would help until you get a follow up. Three months they recommend in Albany.

I would have been on some medication, like Plavix 75 mg and baby aspirin, to help dissolve what was in that stent, that I would not even have known about.

Perhaps the dr saw something else during the first procedure and knew I needed another stent or two. No one knows, do they?

Or, the first procedure was long DH said. Perhaps I needed more time for treatment but too many times the veins were ballooned already and re-checked a few times. I know my Azygos was the tiniest he had ever seen before. He ballooned it in three places and the arch had a blockage he cleared.

There are many scenarios that could have taken place. These drs are still seeing new/odd problems everyday. Our bodies all have different problems inside and out.

Someday this will be a commonplace procedure like all the rest of the procedures and surgeries these special drs are always performing day in and day out.

I don't worry at all about clotting or re-stenosis. I have more trouble trying to keep the INR at the correct level. That is a task for me for some reason.

Taking Warfarin makes food an issue, meds an issue, ever trying to keep my INR steady is hard. Many foods are high in Vit K the clotting vitamin. They are a no-no.

It is getting to be a game now. I had my blood taken today. Tomorrow I will get a call to tell me what amount of Warfarin to take. One pill, one and half every day, or every other day. The fun, NOT!

Maybe I can get off it soon. I am hoping I can switch after my next US about a week from now, when I get my three month check up. Until then I keep doing my mild exercises and walk as much as I can.