Clot query....

Hello all...

Had my dual chamber PM implanted Feb. 1, 2022 for AFib and bradycardia.  Been on Sotalol (80mg bid) and Eliquis (5mg bid).  
Last Thursday after showering I noticed my left arm red and a tad swollen as my watch band was too tight.  Got better during day.  Friday noticed it again.  Called my cardiologist's office and she immediately ordered an ultrasound duplex which I had done that afternoon.  I see her to go over the results tomorrow, Tuesday.  In the meantime I accessed the results via the patient portal. Here's the lowdown:  

FINDINGS:
There is patency of the left internal jugular vein with normal flow.
There are eccentric soft tissue echodensities within the left subclavian vein which
remains widely patent with augmentation.
There is compressibility, flow and augmentation within the left axillary vein. There is full compression with flow and augmentation in the left brachial vein. The left basilic, cephalic, radial veins fully compress. Flow and augmentation not demonstrated within the segments.


IMPRESSION:
1. Nonocclusive peripheral nonmobile clot within the left subclavian vein. This may be chronic.
No thrombus within the remaining imaged left upper extremity veins.


So before I go see the doc, any feedback from others on this?  Anything in particular I should ask  her?  I'm guessing this clot could be from the AFib episodes or quite possibly as a side effect of PM implanted.  Moot point now, so just wondering going forward where I'm at.  I scanned several earlier posts on this, but most are from years back and perhaps "solutions" have advanced since.  (?)

Thanks! 

7 Comments

Just a few ideas ahead of your consultation tomorrow

by Gemita - 2022-07-18 13:27:10

Daedalus, 

I feel the non occlusive, non mobile clot within the left subclavian vein is likely to have been caused by your pacemaker leads/implant surgery, or due to any previous procedures where they may have traumatised your subclavian vein?  I note they are suggesting this clot may have been present for quite some time.   I would ask whether the implant procedure has likely caused this and whether you will need additional intervention or blood thinning treatment in addition to your Eliquis?  

My subclavian vein was traumatised during implant surgery and I had a partial obstruction.  I experienced pressure pain right across my clavicle, going into my left shoulder for months until I developed collateral veins (extra veins) around my device to help bypass the traumatised vein.  This was clearly nature’s way of bypassing the partial obstruction, without which I may have been in more trouble.  I am also on anticoagulation (Edoxaban) for AFib.

Just a few questions I would want answering:-

============

What has caused this clot?  Is it likely pacemaker procedure related?  If cause is uncertain, what other investigations will be needed to rule out other potential causes?

Do I need additional treatment to break up the clot, or can I safely remain on Eliquis alone?  

Will I need any surgical treatment or physiotherapy and what can I do to relieve the discomfort?

Can I safely live with this non mobile, non occlusive clot or am I likely to need further medical intervention in the future?

============

Please let us know what your doctors advise tomorrow and good luck

Thanks....

by Daedalus - 2022-07-18 21:20:02

Thank you, Gemita!  Appreciate your input.  I made note of your suggested questions and will ask them if needed.  By the way, appointment rescheduled for Thursday as she now has an unexpected operation to do tomorrow.  Will update then.

Thanks..... Update

by Daedalus - 2022-07-20 00:33:47

 

My cardiologist got me in this afternoon.  

Plan is for the next three days to double my Eliquis to 10 mgs twice a day in an attempt to dissolve or break up the clot in the subclavian vein.  Then next Tuesday I'll have another ultrasound to compare with the previous one to see if it has dislodged or gotten smaller.  


If that fails, then I go to the main Providence Hospital here that has full cardio facilities.  There they will try to extricate the clot by going up through a vein in my arm. Her concern is the pacemaker wires are there, too, making the procedure tricky and perhaps causing infection. 

The clot wasn't there when the pacemaker was put in and it formed despite my taking blood thinners.  That surprised her. Wants me to also see a hematologist to see if my blood has something that leads it to perhaps cause clots. 
 

Guess I'll see how this goes.  Sigh. 

Sigh indeed😔

by Lavender - 2022-07-20 01:00:21

I'm glad there's a plan in place. How sad to have this worry while you're just recovering from the pacemaker implant. It sounds like your care is good. 
 

I know a few people with genetic blood clotting disorder. They all had at least one blood clot. All are managed with blood thinners. It's good if you find out if you have a disorder. 
 

I am glad you noticed the issue and reported it promptly. Let's hope for a quick resolution of this.

You are in good hands

by Gemita - 2022-07-20 03:25:24

Daedalus,

You are obviously so well cared for and this gives me confidence. 

I am glad that you will be checked by a haematologist for clotting disorders or any illness associated with its potential development. 

Unfortunately clot formation is a known complication of pacemaker insertion, so if this is the case, hopefully the measures planned will be all that is needed to manage the clot effectively. 

Good luck and please let us know how you progress 

Yes, Good Hands

by benedeni - 2022-07-20 11:44:07

Daedalus.  Sorry for these new issues but sounds like Dr. D. is all in for you.  Best of luck, neighbor..  Keep us posted and very best wishes.

Thanks

by Daedalus - 2022-07-20 19:15:59


Thanks responders for your support and help. Much appreciated.  You all stay well! 

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