Deandean,

I was on PREVENT and have remained on low intensity warfarin treatment since. Basically it is preventative treatment (target INR of 1.5-2.0 rather then 2.0-3.0). Not every patient is a candidate for PREVENT due to some long-term patient needing the higher INR to prevent reoccurence of clots.

My first clot was in 1992 (DVT/PE), second in 1995. Since being on PREVENT I have remained clot-free. During the timeframe between my last clot and PREVENT I suffered several superficial clotting episodes.

Most doctors are not aware of PREVENT. Here is some information from one of the original investigator, Dr. Stephan Moll:

http://fvleiden.org/ask/09.html

My doctor who was involved in the Trial was Dr. Sam Goldhaber of Harvard Medical.

If you have any other questions, please message me through this site.

R/
Tom

Hi There,

I have never heard of those specific trials but what I can tell you is using an anticoagulant is SOP with DVT's and PE's. I am a lifer on warafin and from all of my research, there is no other way to treat them than using some sort of anticoagulant. Hope this helps.

neketah, both PREVENT and ELATE related to low intensity warfarin treatment with Coumadin for long-term patients. Researches wanted to know if they could lower the INR levels in long term patients (those not being treated for an active clot and on life-long Coumadin). The idea was lower INR reduced bleeding issues and some of the side effects experienced while on therapeutic Coumadin (higher INR 2.0 to 3.0).

THRIVE III was used when testing the then up and coming oral anticoagulant Exanta. Exanta back in 2004 was touted as the first oral anticoagulant targeted to replace Coumadin (much like Dabigatran and Rivaroxan are today). Problem is Exanta raised liver enzyme levels in patients and caused some deaths here in the U.S.

Exanta was initially approved for use in Europe and Canada for treatment of DVT/PE. While undergoing trials here in the U.S. the liver enzyme issue was discovered and the medication was subsequently removed from market.

Regards,
Tom

Correct me if I'm wrong Tom, but Deandean is not currently on coumadin, so would not be considered for PREVENT therapy - or any long term warfarin therapy unless another clot occures or there is a dx of a strong thrombophilia. It's not like Deandean could walk into the docs office and request being put on warfarin to prevent a clot. In other words, once you're on warfarin for life, then you can talk about low dose therapy - and even THAT doesn't guarantee you can do the low target INR. As in my case. My hematologist refuses to let me go below 2.0 INR.

Deandean, the specter of another clot is frightening, especially when you've had PE's. But if you don't have to be on warfarin for life, that's a good thing. You can take lots of steps to help prevent another clot that don't require a prescription, such as getting plenty of exercise and staying hydrated etc. Do research on the potential perils of long-term warfarin therapy, even low dose, and see if those possible complications aren't just as frightening....

LauraLu,

Thank you for correcting me, I missed that during my reading. Unless you have an underlying medical condition that places you at increased risk of developing clots, have a history of clots, or have certain types of thrombophilia (clotting disorders), normally a doctor will not put you on long-term anticoagulation. Even with a clotting disorder, it doesn't necessarily warrant life long Coumadin (there are exceptions)

If your medical history does warrant long term anticoagulation, the doctors "may" place high risk patients back on Coumadin after they had been off it for some time; it happened to me. However, standard practice is not to do that without justification. Really dependents on the physician and the patients own medical history.

R/
Tom

I have about 4 more months to go on warfarin , I have contacted a world renowned naturopath in Vancouver Dr. John Matsen and they said they deal with people that are about to or want to come off warfarin , regularily and they have very good success , my family Dr and my specialist are both ok that I go this route . so I think it's something to consider.
Ed

Thank you Tom, Neketah, LauraLu and Ed. I very much appreciate receiving your responses along with the good information.

I had the feeling my doctor was not aware of these trials because when I mentioned them, she did not respond. She as directed me to take an aspirin every night and to wear compression stockings.

Looks like taking Coumadin has its own set of risks, complications, etc., so sometimes I wonder if risking another blood clot is the lesser evil. This is all rather scary business. I do not have any of the blood clotting disorders, but since my first episode with DVT and PEs in April, I've had another ultrasound and was told I had a superficial blood clot. Also, the old blood clot was still visible, although I was assured it wasn't going anywhere.

Do any of you have varicose veins, too? I don't think they are a direct cause of DVT, but a vascular surgeon I went to said they contribute to the condition and make it more likely I'll have another DVT. He suggests " vein ablation" and procedures called "microphebectomy" and" vein stripping" of the great saphenous vein.

Although these procedures might cause another clot ( I would have to go on Coumadin again for a few weeks prior), I am considering having them done because of the achy, heavy leg pain I am experiencing. Seems like my legs feel worse since having DVT and PEs- and I am extremely exhausted all the time. Needless to say, I am frighteded to do anything which would raise the risk of another blood clot. (Is this another case of damned if you do . . and damned if you don't?).

Thank you all again for your kind support. Wishing you a healthy and happy New Year. Best regards, Deandean.

I have varicose veins and they do not cause DVTs and I would question what he means that they make you more prone to DVTs in the future. I'm not sure that's exactly true. I'm not a doctor of course, but I have pretty major varicose veins and none have been contributed directly to why I have a DVT. Obviously, it's indicative of overall circulation. I asked my cardiologist about having mine removed and he said he wouldn't do it if he were me, that it could cause more swelling in my DVT leg. Of course he's a heart doctor and not a vascular doctor so he may be coming from a different angle. I'm not sure if he's right or wrong, but I'm staying away from having them removed for the time being I get a little leery when a surgeon is so anxious to get at me.

I meant to say "...overall circulation issues."

I concur with rmb. Whatever damage is done in the leg due to residual scar residue or damaged valve results in other veins helping to move circulation through that leg. A clotting specialist told me years ago to never, ever let a vascular doctor suggest fixing varicose veins or anything else because it would hamper circulation even more.

Wearing properly fitted compression stockings and regular exercise does help, and in some causes can reverse the damage; to some degree.

Regards,
Tom

Thanks for that confirmation, Tom. That makes me feel even more resolved in my decision and confident that I did the right thing by leaving my veins alone.

rmb and Tom,

Thank you for telling me what your docs said. It makes a lot of sense to me. I really did not feel "right" about having these procedures done, but I just attributed it to my being a coward. Sometimes we must trust what the old "gut" tells us, right? Why go looking for more trouble?

I shall not have these procedures done, now. I am very grateful to you for telling me what your docs told you.!

Best regards, Deandean.