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New DVTs whilst on warfarin??
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This is probably a stupid question - but I don't know much about DVTs.

If you are on warfarin, and your INR is at a theraputic range, can you still get new DVTs?

I had DVT and PE on 10th June about two weeks after breaking my foot, and getting plastered (not the alcohol kind sadly). I didn't have any symptoms apart from being SOB - so am now a bit paranoid that it could happen again, and how would I know?

I ask because this morning at about 4am, I began having pain in my calf, and found a small lump. After a quick websearch, i rang NHS Direct. The nurse was really helpful, but I didn't have any of the classic signs. She told me that she'd seen lots of patients who had those symptoms, but an equal number who had no symptoms. I then spoke to an ut-of-hours doctor who told there was no risk, but then told me that if I felt more pain or became breathless to ring 999 straight away. The latter advice seems to contradict the former. It's def still there but it's not got mor painful.

So can anyone advise - can you get new DVTs whilst on warfarin? Very grateful for any light any kind soul an shed. Thanks in advance for reading my ramble.
Posted on 08/02/09, 05:23 pm
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Reply #1 - 08/02/09  5:42pm
" It is possible to have another blood clot while on warfarin and in the standard therapeutic INR range of 2-3. So I've read, anyway. I'm not sure how common it is...in fact I think it's more of a risk if you have a genetic clotting condition, or certain types of cancer that cause a hypercoaguable state. In cases where warfarin does not work, they put you on lovenox (clexane) injections.
Since having my DVT in August of last year, I can tell you I have had all manner of aches and pains in my leg. Swollen lumps are for sure an issue to be checked out, particularly if they get bigger, but in general, if you FEEL a lump it's not a DVT. And if it's not a DVT it won't move to your lungs, or so I'm told.
Hope that helps ease your mind a bit! "
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Reply #2 - 08/02/09  5:57pm
" That is certainly very helpful LauraLu - thank you for easing my mind. Really I mean It. I am trying not to dramatise every little niggle - I've never been like this before, and hate to think I'm turning into a hyperchondriac.

I have to say the smile i your pic is infectious too... "
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Reply #3 - 08/02/09  6:26pm
" My case is similar to yours but things happened in the opposite order. I had the painful calf niggle first, saw the doctors, was told it was in a "surface vein" and therefore "not life threatening", got sent home, and had the PE dx'ed 2 1/2 months later. Though the surface vein clot was harmless in itself, the bad part came in the places to which it spread in the absence of any real treatment.

With that in mind I cast my vote to at least get it checked out and identified as a clot or not a clot. Also, sometimes tests such as a doppler can somewhat distinguish an old clot from a newer one, or if there are indications of both. Getting some indication of where these things are/were and keeping them monitored is part of understanding the progression of your case and part of gaining the best possible recovery.

Also, it would be most insightful to eventually learn if you do have a genetic or acquired clot predisposition that may have contributed to your current situation.

Good luck and Godspeed. "
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Reply #4 - 08/02/09  6:31pm
" Thank you More2be. i will certainly get it checked out and let you know. As to the genetic tsting etc, My INR clinic tell me they do that after about 6 months, when hopefully the warfain stops , owhen they discover you have a longer term condition. --- in fact I have alreadyhad a letter to confirm an appt for 3 December.

From reading other posts, I think they seem to do this earler in USa & Canada - is that right? "
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Reply #5 - 08/02/09  6:47pm
" Not necessarily earlier testing, just smarter testing. I had some degree of genetic screening after 11 mos. The doctor thought one could have no such screening while on warfarin. The more on-the-ball hematologist knew that, at least, one could get tested for Factor V Leiden and for PT20210 (Factor II) while still on warfarin. It was highly practical to do so given that Factor V affects 5% of the caucasian population and is the most common contributing reason for VTE in that at-risk population. I was found to have Factor V Leiden.

Knowledge of the mutation (or lack thereof), together with evaluation of the residual degree of damage, can result in a safer decision of warfarin cessation or warfarin continuation. "
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Reply #6 - 08/03/09  1:06am
" i go through the same with my dvt and pe if ever you get a knot on your calf easliy rub it till the pain goes away.remember not to hard you do want one breakin loose "
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Reply #7 - 08/03/09  3:00am
" Thanks more2be - very enlightening.

It is sooo helpful to know these things. I feel at least I can ask informed questions when I see my doctor --- who is lovely but a general practitioner. Hopefully this will speed recovery because I am taking more control. I am sure we have all got in the cycle of having appts, and then having to have more appts - because we don'tknow what to expect or what to ask. I want as mch of my life back as quickly as possible. It's so hard not to get frustrated with or body - that emotional rollercoaster again.

Thank too Hollywoodtone.

I' "
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Reply #8 - 08/03/09  9:23am
" They tested me for genetic factors right out of the gate too - so I knew in a few days after my DVT that I was homozygous FVL with the presence of lupus anticoagulant.

Subsequent testing for antiphospholipid antibody syndrom and various autoimmune conditions have all been done while I've been on warfarin (and all negative, yay!)I was glad to know early instead of having to come off warfarin, be unprotected for the days and sometimes weeks it takes to get results back, and THEN have a positive dx and have to try and get back to range with my INR. Why some docs insist on waiting to test, like M2B said at least for FVL, is beyond me.
But breaking your foot and having it immobilized in a cast is cause enough for a clot, so whichever way your doc tests, we'll keep our fingers x'd this is a one-time event in your life! "
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Reply #9 - 08/03/09  12:37pm
" Let's hope LauraLu. X "
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Reply #10 - 08/09/09  6:24am
" Well anyway you'll be glad to know I hadn't had anther DVT or PE (Yay!)--- although I did end up back in Hospital or another three days. Alwys good to check. Have had another VQ scan too ang get to find outteh results on 20th august "

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