Most people don't have a second ultrasound, unless there were complications with the clot, the clot was very large or complex, or something like that. Sometimes it just depends on the doc. So it's pretty standard to not have a second one.

Well I would say my clot was kinda complex since it was in my entire upper left leg. My leg swelled up 3 times normal size. Thanks for the input. I guess I was just assuming that they would rescan to see if it went away or grew or whatever.

I am exactly where you are in your DVT diagnosis. 1 week from today will be my 6 months. My PCP said the same thing about no other US or imagining. THEN I saw my hema and he ordered my 2nd US a few weeks ago and I'm SO GLAD I got it because it gave me some peace of mind. The clot was much smaller, residual and I've got blood flow w 60% compression. Whew!
I'll see dr this week about getting off of Xarelto.
Healthy wishes in whatever you decide and I'd love for you to keep me posted on your recovery. Good luck!

Reading your bio and have to say that this has been a life changing event for me as well. One I never saw coming.. I guess it is for is all.

I had the follow up scan before release from the hospital, then another about 6 months after the event. I had a complex one, much like you, with a straddle PE. I can say that it gave me some peace of mind when they did the follow up scans, as it did show progress, so glad that they did it

I am on both sides of the discussion. I want the scan done to see if it is smaller and such yet in some ways I am very afraid of what they see...Kind of like a double edge sword I guess. As of right now my pcp has labs being done next week and then a follow up meeting the week after to discuss my results.
It has been a life changing event to the max that is for sure. I pretty much went cold turkey on a lot of stuff I did, no longer drink coffee or anything with caffeine in it, if I do it is in very small amounts. I really watch what I do and what I eat now more than I ever did 6 months ago. I have set in my mind I am NOT letting it control my life and refuse to get depressed about it.
Went summer clothes shopping this weekend and was very hard to walk out of fitting room wearing shorts and compression thigh highs. I don't care what people think but it is something I am tying to get used to is the "odd looks" and comments some people make.

Considering that you had such extensive DVT then I would personally have an ultraound to check out the degree of recanalisation (i..e how much the clot has been dissolved). If the ultraound shows that you have still lots of residual clots then this may be a risk factors of another DVT and thus a longer anticoagulaiton may be recommended. The general advice is that if the clot is occupying more than 40% of the vein diameter, then a prolonged anticoagulaiton may be recommended. I however understand that you may worry about its outcome.

This is becoming a standard question, but the fact that you got your DVT in the left leg, has May Thurner been ruled out? It is rare but affects mainly younger women and nearly always affects the left leg.

With respect to compression stocking, the embarrfassment is even greater for us the men being spotted in compression stockings :) I mean, guys, what do you do when you go to the beach? For me, the days of shorts are basically over...:(

I think embarrassment over compression stockings really goes beyond gender. But seriously, as a woman, they make you feel incredibly unattractive in ways that I don't think a man can truly appreciate.

As far as a second ultrasound, you can ask to have one. The question becomes if it's considered "medically necessary" and that's what often determines if a second one is warranted. And what is determined medically necessary is based on standards and protocols and clinical rationals. They don't had out ultrasounds like candy, usually. Doesn't hurt to ask for it but I would wait to see how your blood work comes out first. If they're doing a d dimer and it's not elevated, there may be no real benefit to having a second ultrasound.

In the end, the decision of whether to have another ultrasound or not is the decision of the patient after hearing the views of the doctor.

However, in my opinion, I would be reluctant to base the decision on whether to have ultrasound or not on the basis of the D-dimer tests only. The D-dimer will provide information on whether clotting is taking place or not, but not about the state of the veins after 6 months following DVT. State of the veins can provide clues on the risk of another DVT when off anticoagulaiton, and this is prevalent considering how extensive the DVT was. However, this only my opnion.

I don't know what compression level you've been wearing, but you can find some cute compression stockings out there. I've ordered from this company before:

http://www.rejuvahealth.com/

I have a red lace pattern that they don't offer anymore, but they have other patterns and other colors with dots, roses, etc. They only sell 15-20mmHg or 20-30mmHg, though, so if you need something stronger you can't get it from them.

Stefan, if that's the case, that it brings value to determining whether you may have another DVT, then why do so many doctors not recommend a second ultrasound?

No idea. When I had my DVT I asked 4 doctors about the length of my anticoagulation treatment. The answers were.
doc 1: 3 months,
doc 2: 6 months:
doc 3: stay on them as long as I had residual clot, at least year or more
doc 4: up to me...

I guess this applies as well to what doctors feel about the need of another ultrasound or not. In my view it also depends on how extensive the original DVT was. As an example, if it was below knee, then there is generally no need for another ultraound. If the whole legs clots, then it could be useful. I guess all DVT patients cannot be put into one box with respect to usefulness of another ultrasound. But I guess there as many views on this as there are doctors. Personally I formulate my view based on the scientific literature about the subject. If a large robust clinical trial suggests this or that, then I consider that as the best advice (naturally I ask for doctors approve on that if this applies to my case). I guess I could write one day a message on the predictors for the 2nd DVT and PTS based on findings from ultrasounds.....

I'm not asking you to research it. I'm just trying to work through the logic in how you mentioned a second ultrasound may predict a future DVTs and yet the medical community generally doesn't do a second ultrasound. That makes me believe it's either not that accurate of a predictor for recurrence or that because most clots resolve within 6 months, this in itself lessens the risk of recurrence. I'm just speculating.

I've been told by my doctors that about 50% of patients have some residual or chronic clots after a DVT with just standard anticoagulation treatment and the greater the extent of the DVT the greater the chances of having residual clots. Especially true is the clot is above the knee or if the patient did not receive sufficient anticoagulation the first few weeks.

The more residual clot the greater the chances of having another DVT. Your veins aren't so smooth anymore and you may even have webbing - this roughness and narrowing of the vein just makes it more prone to clotting even if you are not genetically prone to clotting. And then of course many people end up with damaged valves.

The reason so many doctors don't do another doppler is because they are using older standards and they are just not up to on the most current research. This unfortunatly happens more often if you are just seeing your primary for your blood clot. When you think about it how can primaries stay on top of every medical issue? it is just not possible.

And then of course, if you are in an HMO they may decide not to do another doppler to save money. Statistically, you are more likely not to clot again than clot. I hate to say it, but insurance can and does make a difference in the treatment patients recieve.

Some of the newer research is starting to suggest that antcougulation should be 18 to 24 months even -- not the standard 3 to 6 months. The patients that stay on that long seem to have a significantly lower chance of having a second clot. And while specialty doctors may suggest this longer antcougulation, I think it would be very unusual for a primary to suggest it.

My primary is in a teaching hospital/practice so she stays pretty up to date and I often see 3rd year medical students with her that question everything, but even in this setting they are just not as up to date on the most current treatments for blood clots as my hematologist and interventional radiologist are. And I wouldn't expect them to be either.

Hi rmb

To me the logic is to evaluate/predict, on the basis on the findings of the ultraound, and other medical observations, the risk of re-clotting after stopping on antocoagulation. This is often very difficult to predict and scientists/doctors fall into two groups in this respect. The first group argues that it is very difficult to predict recurrence of DVT; there is simply to high uncertainty; and thus it is best to use the standard protocol of 6 months anticoagulant treatment for those with proximal DVT (the length may vary between patients depending on whether the DVT was idiopathic or not). The second group argues that there are reliable predictors for DVT recurrence that that can be evaluated on the basis of various medical observations e.g. 1) physical and visual observations of DVT/PTS symptoms (e.g swelling and redness), 2) state of the vein valves (doppler/venogram/ultrasound), 3) state of theu veins e.g. flexibility, scarring(ultrasound), 4) degree of residual clotting (ultrasound). 5) overall health (e.g. obesity), 6) underlying clotting factors, e.g. genetic mutaions (blood tests), 7) underlying diseases that can promote clotting (e.g arthritis, cancer) and 8) the cause of the original DVT (transient vs idiopathic).

The risk of of clotting increases after stopping on anticoagulation, and in some cases it does not matter if the patients is on 6 or12 months on anticoagulaiton or not, but in other cases it does. The question is therefore to put all patients with proximal DVT into a single category when deciding on the length of anticoagulaiton treatment (favoured by group 1) or whether to evaluate each patient on a case by case basis (favoured by group 2). Personally I favour the second approach. My argument is that the right time to stop anticoagulation is when the probability of recurrence has become as low as it can be (this can be difficult to predicted). Second DVT can mean a life-time anticoagulaiton, so I would prefer to stay longer time on anticoagulaiton after the first DVT rather than staying too short, if this can mean that the risk of having another DVT is sufficiently reduced.

In the end, ultrasound of the leg is a relatively quick operation and has never been shown to impose any harm what so ever. Perhaps the issue here is that ultraound is expensive, but I really cannot comment on that how the system is in US with regards to insurances.