Dear Colleagues

Large lady with COPD and heart issues had ankle fusion (9th May)

Was given 150mg aspirin as thromboprophylaxis for 6/52

Large proximal clot diagnosed on 4th July

Has been told that it is provoked and only requires 3/12 anticoag, but this is 2 months post op and the opposite leg??

I have ensured that she is referred to the thrombosis Clinic and to stay on anticoag until seen, 

thoughts anyone?

 

 

 

My first thought Sue is why did they use Aspirin for thromboprophylaxis  - that isn't right is it or have I missed some guidelines that say different?

When you say large lady - how large? Our Aspirin guidelines for THR and TKR say to use LMWH or apixaban if they weigh over 150kg and I think if I remember correctly Leicester say that too 

It does fall within the 90 days so theoretically it is a provoked HAT but I agree with you that it needs further investigations - I've had a 38 year old man referred to my provoked clinic with a high d-dimer and the provoking factor stated on the referral being a CRP of 214 at the time of the DVT diagnosis but to be fair it was a very extensive DVT so I'm referring him on to the Consultant clinic for further review as I'm not happy either 

Basically, I agree, needs further review and not stop at 3 months if the clinic appointment hasn't happened at that point 

thanks Alex

Not sure about why they used the aspirin - am chasing that up.

would you guys have given LMWH? 

We are not great at assessing lower limb issues  -  I am hoping that the TiLLi trial will help with this

I think you’ve taken the right approach. Continuing anticoag and waiting for specialist input is safest in this situation.

Yes — deep vein thrombosis (DVT) can occur in the non-operated leg. Surgery increases overall risk of venous thromboembolism due to immobility, systemic inflammatory response, and hypercoagulability, not just local trauma. Therefore, DVT can develop in either leg (or elsewhere), even if only one leg was operated on.

Good decision to refer her on. The fact that the clot developed 2 months post-op and in the other leg raises questions, so the thrombosis team will give the safest guidance.