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I Have Had 2 Dvts Pes With Neck Cancer What Are Precautions I Need To Take
Posted on
Wed, 5 Sep 2018
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 5 Sep 2018
Answered on
Wed, 4 Oct 2023
Last reviewed on
Question : I have had 2 dvts pes The last one was 5 years ago unfortunately no one started testing until I was on lovenox after the second but they believe I have a protein c and s deficiency. I had head and neck cancer 5 years ago with surgery chemo and radiation all okay. I tried the latest drugs and do the best on coumadin I have a home monitor and log in to a med company that fax’s the doc if Rx needs to be adjusted. I have read up on this and know home monitoring can be the most successful. The XXXXXXX unit is convenient and easy to use. I now have three cardiologists who are refusing to write for a bridge with lovenox for a procedure. They want me to get rid off the home monitor and walk in once a week to a lab. This is covered by my insurance and they supposedly participate but are fighting. Do I need to find someone else. I don’t think I want to be with a doctor who does not want me as a patient or cannot be bothered
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and I am sorry to hear about those inconveniences regarding the current anti-coagulation monitoring strategy.
I agree with you that having a home monitor seems a rational approach to Coumadin dose adjustment as far as the equipment is regularly (periodically) calibrated and its use is approved by the local regulatory medical authorities.
Actually it is difficult to explain the exact reason why your attending doctors are fighting against the idea of continuing on such a strategy.
Probably they have raised safety issues regarding those home monitors, which in fact may give imprecise results in case thy are lacking good technical calibration. This alternative may explain why they have requested instead lab anti-coagulation monitoring.
In fact switching to a low molecular heparin like Lovenox when in front of an invasive procedure is a widely acceptable and utilized protocol in patients on chronic oral anti-coagulation therapy.
There has been a trend recently toward new oral anticoagulants (like Apixaban, Rivaroxaban, etc.) the so-called NOAC strategy which don't need periodic anti-coagulation control as they are usually prescribed on a constant daily dosage.
I don't know whether your doctor have proposed you NOAC instead of the classical anti-coagulation strategy (with anti-vitamin K agents, like Coumadin).
On my personal professional opinion, considering your previous medical history (deficiency of coagulation cascade proteins and your previous oncology records) your currents anti-coagulation strategy with Coumadin appears more effective in case you can manage to maintain the necessary daily dosage for an appropriate therapeutic control.
In other words, if your home monitor is functioning properly and are approved and no safety issues have been raised by the regulatory medical authorities there is no any firm medical reason to fight against it.
This is especially true in case your daily Coumadin dose control has been effective on such a strategy and there has not been any recent claim from the part of the health insurance on a possible expensive service.
Anyway, whichever be the exact reason; I think that before deciding on a possible doctor change, the most reasonable approach would be to discuss again with your actual attending cardiologist regarding the above mentioned issues and find out the exact cause of his refuses.
In case you provide me with more specific information (regarding the kind of the procedure you are planning) and further available details I could give a more concrete professional opinion.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and I am sorry to hear about those inconveniences regarding the current anti-coagulation monitoring strategy.
I agree with you that having a home monitor seems a rational approach to Coumadin dose adjustment as far as the equipment is regularly (periodically) calibrated and its use is approved by the local regulatory medical authorities.
Actually it is difficult to explain the exact reason why your attending doctors are fighting against the idea of continuing on such a strategy.
Probably they have raised safety issues regarding those home monitors, which in fact may give imprecise results in case thy are lacking good technical calibration. This alternative may explain why they have requested instead lab anti-coagulation monitoring.
In fact switching to a low molecular heparin like Lovenox when in front of an invasive procedure is a widely acceptable and utilized protocol in patients on chronic oral anti-coagulation therapy.
There has been a trend recently toward new oral anticoagulants (like Apixaban, Rivaroxaban, etc.) the so-called NOAC strategy which don't need periodic anti-coagulation control as they are usually prescribed on a constant daily dosage.
I don't know whether your doctor have proposed you NOAC instead of the classical anti-coagulation strategy (with anti-vitamin K agents, like Coumadin).
On my personal professional opinion, considering your previous medical history (deficiency of coagulation cascade proteins and your previous oncology records) your currents anti-coagulation strategy with Coumadin appears more effective in case you can manage to maintain the necessary daily dosage for an appropriate therapeutic control.
In other words, if your home monitor is functioning properly and are approved and no safety issues have been raised by the regulatory medical authorities there is no any firm medical reason to fight against it.
This is especially true in case your daily Coumadin dose control has been effective on such a strategy and there has not been any recent claim from the part of the health insurance on a possible expensive service.
Anyway, whichever be the exact reason; I think that before deciding on a possible doctor change, the most reasonable approach would be to discuss again with your actual attending cardiologist regarding the above mentioned issues and find out the exact cause of his refuses.
In case you provide me with more specific information (regarding the kind of the procedure you are planning) and further available details I could give a more concrete professional opinion.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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