DVT, PE and blood thinners.

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CKinnard
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Re: DVT, PE and blood thinners.

Postby CKinnard » Sat Jun 16, 2018 7:23 pm

ValleyForge wrote:Greater blood flow has never been correlated with intimal hyperplasia. Turbulent yes, but not greater flow.


I presume you are referring to a lack of correlation between endurance athletes and IH.
Turbulent flow is associated with high flow, as well as whole blood viscosity changes related to hydration state.
It's most plausible that endurance athletes generally have a healthier diet with lower inflammation and oxidation; and this gives some protection against turbulent flow and IH.
But if you combine a few hundred thousand km's of cycling and a junky fast food diet....

The iliac artery and veins service pelvic, buttock, and lower limb fat which increase substantially in both sexes with a higher bodyfat %, so you still get stretching of these veins....and if they are already IH damaged, then what's the additional stretching going to do?


ValleyForge wrote:Can you explain what similarity you are referring to?


The similarity that varicosities are asymmetrical in cyclists.

ValleyForge wrote:This is not any recognised mechanism. In fact, intra-abdominal pressure is usually negative, not positive. Venous return from visceral fat is not via the iliac veins or vena cava. Can you explain how these vessels are implicated?


Research the relationship between central adiposity and IAP; and respiratory cycle and IAP.
Can you advise normative IAP values during the third trimester of pregnancy, and variation between standing and supine or sidelying?
IAP and venous return is adversely effected in pregnant obese women.
Can you advise if varicose veins during pregnancy are all hormonal.

ValleyForge wrote:Unless I am mistaken, veins down "supply" anything.


yes, you are right I should have said iliac veins to service blood return from greater mass.

ValleyForge wrote:This is not based on any recognised mechanism. Intra-abdominal pressure is usually negative; intra-thoracic pressure even more so.


refer to IAP and BMI relationship again.
review intra-thoracic pressure and venous return during the respiratory cycle, though I didn't raise that.
I was focusing on venous return from the lower limbs and the effect of increased bodyfat, especially central adiposity.

ValleyForge wrote:Mechanical stress yes. The systemic inflammatory markers that are elevated in several vascular conditions (Beurger's esp.) definitely.

Completely different systems. Systemic hypertension (high blood pressure) does not lead to increased venous blood pressure.


They have different pressures yes (physiology 101), but they both degenerate in the presence of systemic inflammation and oxidative stress, and no doubt are both adversely effected by extreme volumes of repetitive mechanical kinking.

ValleyForge wrote:Look, I agree that the human vascular system is fascinating and its embryology even more so. Not even NBNCo could have come up with something so convoluted.
Turbulent flow and some inflammatory processes cause intimal hyperplasia; turbulent flow from non-anatomical kinks in the vessel, loss of the original smooth endothelial lining and hyper-viscosity syndromes among others. There are a few band/obliteration syndromes too - 12th rib and arcuate ligament syndromes are amongst the best defined. There are several others purported, but lets leave them as minutae.


Turbulent flow in the arterial system is associated with hypertension; and whole blood viscosity which is associated with hydration state.
It's clincially irresponsible to dismiss factors that lead to greater bodyfat as being inconsequential to arteries AND veins.

Airies
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Re: DVT, PE and blood thinners.

Postby Airies » Tue Jun 19, 2018 9:06 pm

It's lgbran here,
I try and ride 100ks a week and tow 30-50ks on my indoor rower. I've stacked on the weight. My residual clotting in my right leg doesn't bother me. My left leg occasionally aches post ride or row and is noticebly bigger. I'd love to get it all fixed as the thought of having my major artery in my leg blocked below the knee and above does play with my head.
I'm on rivoraxabran for life. Great drug but if you fall off and bleed you are rooted according to my specialist as there s no antidote. I ride very carefully. When I see my specialist again next year might see if he can do something. Wave a mGic wand and fix my arteries. I'm excercising eberyday, walking, cycling or rowing and plan to do so as long as I can. If I can get my diet in check that would help, small steps. Thank god for the medical profession.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Tue Jun 19, 2018 9:49 pm

Airies wrote:It's lgbran here,
I try and ride 100ks a week and tow 30-50ks on my indoor rower. I've stacked on the weight. My residual clotting in my right leg doesn't bother me. My left leg occasionally aches post ride or row and is noticebly bigger. I'd love to get it all fixed as the thought of having my major artery in my leg blocked below the knee and above does play with my head.
I'm on rivoraxabran for life. Great drug but if you fall off and bleed you are rooted according to my specialist as there s no antidote. I ride very carefully. When I see my specialist again next year might see if he can do something. Wave a mGic wand and fix my arteries. I'm excercising eberyday, walking, cycling or rowing and plan to do so as long as I can. If I can get my diet in check that would help, small steps. Thank god for the medical profession.


The FDA has approved the first reversal agent for rivoraxabran and apixaban (what I am on), so things are looking up.

https://www.dicardiology.com/article/fd ... coagulants
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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ValleyForge
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Wed Jun 20, 2018 10:35 pm

queequeg wrote:The FDA has approved the first reversal agent for rivoraxabran and apixaban (what I am on), so things are looking up.

https://www.dicardiology.com/article/fd ... coagulants

Currently there are readily available products that overcome the effect of the anti-platelet agents. I wouldn't call them "antidotes" though and this recombinant Factor Xa is quite elegant.
As a form of reassurance though, if you are on a Factor Xa inhibitor, you are not "rooted" if you suffer trauma or need an operation. It is vital though that first responders and treating teams know so the information can be acted on.
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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Thu Jun 21, 2018 1:24 pm

ValleyForge wrote:
queequeg wrote:The FDA has approved the first reversal agent for rivoraxabran and apixaban (what I am on), so things are looking up.

https://www.dicardiology.com/article/fd ... coagulants

Currently there are readily available products that overcome the effect of the anti-platelet agents. I wouldn't call them "antidotes" though and this recombinant Factor Xa is quite elegant.
As a form of reassurance though, if you are on a Factor Xa inhibitor, you are not "rooted" if you suffer trauma or need an operation. It is vital though that first responders and treating teams know so the information can be acted on.


I just need to update my Road ID badge to indicate apixaban usage before I start going out on big rides again. I have not had any nuisance bleeding, and I don't seem to bruise anymore easily than I used to. I have also not had to suspend usage for either of my surgical procedures since going on the drug.
I am currently on low dose aspirin in additional to the apixaban, just until I have my followup scan next week. I am assuming after that I will be just back on the apixaban alone, and I am hopeful that after 12 months I will be off the thinners for good. It will all depend on how my body deals with the stent, but once it has an endothelial coating the risk of further clots should be reduced. Coming back negative for any clotting disorders was a relief.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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ValleyForge
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Sun Jun 24, 2018 5:57 pm

queequeg wrote:I have not had any nuisance bleeding, and I don't seem to bruise anymore easily than I used to. I have also not had to suspend usage for either of my surgical procedures since going on the drug.

Yes - the "easy-bleeding" is very individual. You are probably one of the 20% who don't get a significant change in bleeding with trauma or operations.
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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Tue Jun 26, 2018 12:34 pm

Saw the surgeon for my followup today.

Veins are open and blood is gushing through them like a river. The collateral veins have pretty much vanished from the US Duplex, a sign that everything is now going via the most direct route.

I have been cleared to resume riding, but have not been cleared to crash. I am on the thinners for at least another year (Apixaban), and he has me on low dose Aspirin until I see him for another followup in 4 months.

Looking forward to some riding!
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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jules21
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Re: DVT, PE and blood thinners.

Postby jules21 » Tue Jun 26, 2018 1:02 pm

queequeg wrote:I have been cleared to resume riding, but have not been cleared to crash. I am on the thinners for at least another year (Apixaban)

Image

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Tue Jun 26, 2018 4:34 pm

jules21 wrote:
queequeg wrote:I have been cleared to resume riding, but have not been cleared to crash. I am on the thinners for at least another year (Apixaban)

Image


That about sums it up...was glorious seeing that on the Ultrasound!
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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ValleyForge
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Tue Jun 26, 2018 7:28 pm

queequeg wrote:That about sums it up...was glorious seeing that on the Ultrasound!


Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.
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trailgumby
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Re: DVT, PE and blood thinners.

Postby trailgumby » Tue Jun 26, 2018 8:17 pm

I'm on 20mg Xarelto (rivaroxaban) daily and have been noticing an increased proclivity to saddle sores and irritation/inflammation injuries around my knees, particularly where the ITB passes the joint. Some other issues with inflammation around my eyes' melbomian glands I'm starting to worry about. Also a few unexpected spontaneous nose bleeds.

However, no increased likelihood of bruising. For now I'm going to continue working on training to correct the issues in my pedalling action which I'm told contribute to my dodgy knees, but I'll be raising it with my GP.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Tue Jun 26, 2018 8:47 pm

ValleyForge wrote:
queequeg wrote:That about sums it up...was glorious seeing that on the Ultrasound!


Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.


The drug the surgeon mentioned was Paclitaxel, which is a chemo drug, but it also used to limit restenosis in stents.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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ValleyForge
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Wed Jun 27, 2018 11:19 am

queequeg wrote:
ValleyForge wrote:
queequeg wrote:That about sums it up...was glorious seeing that on the Ultrasound!


Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.


The drug the surgeon mentioned was Paclitaxel, which is a chemo drug, but it also used to limit restenosis in stents.

Yup. Best avoided though - it's like a blowtorch being used to heat babies milk. It works, but....
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g-boaf
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Re: DVT, PE and blood thinners.

Postby g-boaf » Wed Jun 27, 2018 11:30 am

queequeg wrote:
ValleyForge wrote:
queequeg wrote:That about sums it up...was glorious seeing that on the Ultrasound!


Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.


The drug the surgeon mentioned was Paclitaxel, which is a chemo drug, but it also used to limit restenosis in stents.


That drug has some awful potential side effects. :shock: I think it would also stop you from getting out on the bike because of the side effects and risks.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Wed Jun 27, 2018 11:34 am

ValleyForge wrote:
queequeg wrote:
ValleyForge wrote:
Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.


The drug the surgeon mentioned was Paclitaxel, which is a chemo drug, but it also used to limit restenosis in stents.

Yup. Best avoided though - it's like a blowtorch being used to heat babies milk. It works, but....


Which is most likely why he said we'll only do it if and when the intimal regrowth happens. Looking at the pretty pictures of my vein from the CT, you can see an obvious narrowing of the vein, which suggests I have had this all my life. I need to find a computer with a more recent DVD player in it, because the one I have keeps rejecting all the DVDs from the US Scans. Either that, or the physical format of the discs is not compatible.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Wed Jun 27, 2018 11:39 am

g-boaf wrote:
queequeg wrote:
ValleyForge wrote:
Lets hope it stays that way more importantly - Vascular Surgery is the art of what's possible as the original pathology progresses.
BTW there are additional medications that can be used to reduce aggressive intimal regrowth I understand.


The drug the surgeon mentioned was Paclitaxel, which is a chemo drug, but it also used to limit restenosis in stents.


That drug has some awful potential side effects. :shock: I think it would also stop you from getting out on the bike because of the side effects and risks.


When used for treatment of restenosis, it's a localised delivery straight to the inside of the vein wall at the affected site. They even make stents that are coated in the stuff, though in my case the surgeon obviously though I didn't need a drug-eluting stent, and opted for bare metal.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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