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Deep Vein Thrombosis

DVT: A Risk Worth Taking?

As a physician's assistant, Diane was aware of the side effects associated with taking birth control for her endometriosis. Was deep vein thrombosis (DVT) a calculated risk worth taking?

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I had just injured my left ankle while moving into our new home, when I noticed an increased amount of pain and inability to walk that seemed out of character for the injury. I was seen and treated in the local emergency room for what they thought was plantar faciitis, inflammation of the tissue surrounding the bottom surface of the heel bone. I was given a flat boot and sent home with my left foot wrapped in an ACE bandage. After about two or three days, I noticed an increased amount of pain and swelling, and I was unable to bear weight on my foot.


I discussed my situation with my physician and mentioned to her that I was concerned about a possible blood clot – also know as deep vein thrombosis (DVT). In addition to the injury and my sedentary condition due to experiencing pain for three days, I was also taking birth control for endometriosis (I am a non-smoker). Because of my medical background, I knew birth control pills can increase your risk of developing blood clots. I requested my physician order an ultrasound of my left leg and calf and, during this process, two DVTs were found in my lower extremity. I was immediately taken to the emergency department where they initiated treatment with Lovenox®, an injectable medication that alters the blood’s ability to clot, and consulted with Vascular Medicine. After several days of treatment, I did well and the pain subsided.


As part of my treatment, it was important that I maintain my INR levels with a steady, healthy diet and monitor my Coumdin® doses weekly. INR is a way to measure the clotting tendency of your blood, and Coumadin® is a medication that helps normalize INR levels. I did well and was taken off the Coumadin® at the end of the third month.


Dr. Marcelo Gomes, a vascular medicine physician, continued follow-up with me at the six- and 12-month intervals. Other than occasional muscle spasms and aches, I have done well. Actually, my symptoms have mostly resolved completely with no more aches or nighttime pain in my left leg. I have continued with elastic compression stockings at 30-40mmHg daily since the day I was diagnosed and will continue with them for "life" per Dr. Gomes. These stockings help with blood flow, and aid in the prevention of future blood clots.

One of my objectives now is to lose weight and reduce my risk of the blood clots returning. I have been tested for clotting disorders and have only tested positive for MTHFR, a genetic defect that only affects my ability to conceive/miscarry. This isn't an issue at this time due to infertility which I diagnosed eight years ago. I am no longer on any estrogen therapy (birth control) since the day of DVT diagnosis. I have the option to pursue progesterone therapy should my endometriosis become unbearable or become a concern for my gynecologist.


I will continue to see Dr. Gomes yearly and will wear my compression stockings daily to help prevent the re-occurrence of the DVTs.


My suggestion is that no matter what age - whether a smoker or non-smoker - you should use caution with possible side effects of estrogen therapy. It has not been determined that the estrogen was a contributing factor in the development of the DVTs, but combined with my injury and bed rest for several days, it may have predisposed me to the incidence of blood clots. Otherwise, I suggest that you follow-up when an injury (especially to an extremity) does not resolve as anticipated, or if it worsens, to assure there are not further complications such as blood clots.


Diane Szalkowski is a physician's assistant in Ohio. 

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