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Stents and Blood Clots
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Stents and Blood Clots

Is it likely that having  a stent placed in a heart artery could cause a blood
clot later-- weeks or months-- in the same leg in which the catheter is inserted,
or either leg?
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39 Comments Post a Comment
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976897_tn?1379171202
When they remove the catheter from your leg, they put an angioseal in there to seal the artery and prevent bleeding. You usually feel a lump, where the incision was made. This slowly dissolves over a period of 90 days. It is very rare to form a blood clot because of the inhibitors you are taking, such as plavix. They usually test your blood to see your clotting factor and if necessary other clotting inhibitors are used, but most people only need aspirin/Plavix(clopidogrel).
If you had a blood clot in your leg you would feel quite a lot of discomfort.
What is the reason for you asking?
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Avatar_m_tn
I asked because this happened to me-- 10 days after I had a stent procedure,  I developed
a deep vein blood clot in the same (r) leg, for which I was hospitalized and treated. At
the time of discharge from the stent procedure, there was no mention of any possibility
of that happening,  and no instructions regarding preventive measures, like not sitting
in the same place for long periods of time, and not flying  (I was actually told that there
was no reason I could not follow through on a planned trip overseas-- a 9 hour flight).

And when the clot developed, I was told that it was not connected to the stent procedure
at all-- just a coincidence.  But it seemed to me that it might be more than a coincidence.
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976897_tn?1379171202
When I had my first stent I was told no flying for 6 weeks. I was given an instruction booklet to explain all complications following stenting and what to look for. Maybe it all comes down to the Doctors and the hospital? or good old management.
I have to agree with you, it does sound more than a coincidence.
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Avatar_f_tn
When my husband received his stents, he was told no flying for 6 weeks, no long car rides, and to keep his legs elevated as much as possible for a week, preferably above the heart level.  A nine hour flight can cause a clot in anyone, and this is why we are told to get up and walk around, wiggle your toes etc.  I don't think it's coincidence, I think you were mis-informed.
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976897_tn?1379171202
Your doctor isnt a serial killer is he?
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Avatar_f_tn
Husband's recovery was quick and problem free, he feels and is doing great, no problems.....maybe he just had an excellent doctor from an excellent teaching hospital....
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Avatar_m_tn
This was an experienced interventional cardiologist at a major teaching hospital in the New York metropolitan area-- ranked quite  high for cardiology by US News.  After the clot developed, neither he nor any of several attending MDs thought there was any connection.  I would think that if there is a risk, as your experiences seem to indicate, that they would go out of their way to let patients know about it-- if for no other reason than to avoid a malpractice suits in the event of a stroke or worse.  

I'm trying to give them the benefit of the doubt. Is it possible that you got the "no fly" instructions for a related condition, or other complication of some previous condition, and not just the stent emplacement?
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976897_tn?1379171202
With me the flying comment was verbal, the booklet was instructions should bleeding occur and the signs of stroke etc.
If you google flying after stent, then lots of sites appear. Most say a 2 week restriction but i cannot find any which say there is no restriction. Here is something interesting....

Researchers at Yale University have proposed guidelines for patients with cardiovascular diseases who wish to travel by air. To produce their guidelines, published in the July 20, 2004 issue of the Annals of Internal Medicine, the authors compiled data from numerous studies on air travel and heart disease

Patients should not fly if:

they have had a heart attack (myocardial infarction) within the past two weeks
they have had coronary artery stent placement within the past two weeks
they have had coronary artery bypass surgery within the past three weeks
they have unstable angina, poorly controlled heart failure, or uncontrolled arrhythmias

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Avatar_m_tn
Thanks for this info.  In my situation, the flight was going to be 3 1/2 weeks later,
so perhaps that's why they didn't say anything. But there was also nothing in the
written discharge instructions that had anything about flying, or not sitting for long
periods of time, etc. Other people  I know that have had stents also had received
no restrictions--  so it seems to be inconsistent practice.  

From what I have seen on the internet, there seems to be a concern about clots
forming in the stent itself, rather than elsewhere, as in my case.  

Had you had any other condition/procedure before the stent that would have warranted
the 6 week restriction-- heart attack, or valve condition.  
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Avatar_m_tn
Another thought-- my clot materialized exactly 14 days after the stent emplacement
(13 after discharge).  

I was also scheduled to have a second stent emplaced 15 days after the first, so maybe
they were observing a two week high risk period-- without saying anything about that.
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976897_tn?1379171202
If they knew you was in a high risk period for developing a clot, I'm sure you would be on additional anti clotting agents along with plavix/aspirin, such as clexane or warfarin.
I did have a heart attack before my first stent, but everyone in the ward including those who had not suffered MI were being told 6 weeks no flying time. I think the english just tend to be very cautious to be on the safer side. When it was standard to be on plavix for  year, I was on it for nearly 2.
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315318_tn?1353255400
I had a DES stent put in my LAD two weeks ago at a teaching hospital in the Northeast USA. So far no evidence of any clot in the leg but ever since the procedure, I get muscular pain in my hip & thigh when i walk say two blocks. The pain goes away if I stop walkng or sit down even for a minute. Then I  can resume walking and the pain comes back after walking a similar distance. I have wondered whether this has anything to do with the catheterization procedure or am  I just noticing now symptoms of Peripheral arterial disease (PAD) ?
I should add that the pain is more pronounced on the right hip and thigh. The catheter was inserted from the right groin.
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Avatar_m_tn
Following your reference to it, I downloaded the Annals of Internal Medecine article. The
recommendations referred to seem to be related to someone who has had a heart attack, after which stents were emplaced.  Also, the main risk seems to be blood clots
forming in the stent itself.

I never had a heart attack, just angina, and then the stents (2), and one still be be done,
so that may explain why I wasn't given any restrictions  (though I now certainly wish
I had been, esp. regarding sitting in one place for long periods of time).

Re the 6 week restriction that you were given, that is the recommendation from the
Aerospace Medical Association for persons who have had a "complicate myocardial
infraction."  If that's what you experienced, then that recommendation was the right
one. (p. 149).

In case you haven't read it, and have trouble accessing it, if you send me your regular
e-mail address I can send it to you  as a .pdf attachment.    
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Avatar_m_tn
I also had my stent placed in the LAD, through the right groin, and I also had some
hip/thigh pain for a while-- I don't remember how long.  The cardiologist didn't seem
concerned about it, and it went away.  
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315318_tn?1353255400
How did they find out about the clot in your leg ? Did you have any symptoms?
Thanks.
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976897_tn?1379171202
If restenosis is going to occur in a stent, it usually occurs within the first few weeks of surgery. In a high altitude flight, the cabin is pressurised to around 10,000 feet above see level and this means there is slightly less oxygen in the air.
I suppose if you need to fly immediately after stenting, then there is no problem if you ensure there is a medical expert onboard who knows about your condition. If you deteriorate, they can administer GTN and oxygen immediately. I'm not sure what an airlines policy would be IF they knew a passenger had very recently had heart surgery.
Some doctors claim there is no real risk after bypass surgery or stenting, even if MI was involved but I think we need to keep a level of common sense here. I'm sure some doctors just want to be in the headlines.
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Avatar_m_tn
You seem to have a great deal of knowledge about many aspects of heart conditions,
so I would like to ask your opinion about a couple of things, not directly related to
the "blood clot" subject, and would appreciate your take.  (If you think I should post this as a new thread, let me know).

- when an MD, following angiography, says that an artery is blocked 80% or 95%, how
  can they tell that with such precision?  

-After having 2 stents in one artery (LAD) I was advised to return in the near future for
a stent in a second artery.  The reason the surgeon said it should not be done at the
same time is because of the side effects of the iodine contrast medium.  But doesn't
the iodine medium circulate throughout the vascular system once it is in there-- so
that it would actually be better to have had the second stent done at the same time,
rather than have more iodine contrast next time?
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Avatar_m_tn
First, there were symptoms-- my leg was swollen ankle to groin, about 50% larger
than its normal size.  Thinking this was related to the stent I had received, I went to
the cathlab, where they did a doppler ultrasound which revealed the clot.  I was put on
intravenous heparin immediately,  and remained in the hospital for 6 days.  
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976897_tn?1379171202
The precision is quite easy because the scale of the blockage is actually seen on the angiogram. You can see the vessel in front of the blockage and how much blood is managing to pass it.
I was on the table for 3 hours when they put 5 stents into my LAD. Different people react in different ways to the dye used and the signs are seen on your obs shown on the monitor. The last thing they want is for your heart to start going into A-fib during the procedure, especially if they are carefully trying to line up a stent. I went into a-fib after the treatment. I remember going very light headed and my heart was racing at over 200 bpm. I was injected with strong meds to knock me out and given a shock to contract all the heart muscle at once, resetting the electrical signals through the chambers. I'm glad I only needed the one mild shock and that it worked. Statistics say it works in around 90% of cases. If your other blockage was life threatening then of course they would have treated this first. I believe the dye is filtered out of the body in approx 24 hours.
Mild allergic reaction is usually felt as a warmth and this is very common. It is also interesting to note, there is no test to define if you are allergic to the iodine prior to the procedure, skin tests have proved false.
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976897_tn?1379171202
"But doesn't
the iodine medium circulate throughout the vascular system once it is in there-- so
that it would actually be better to have had the second stent done at the same time,
rather than have more iodine contrast next time?"

Yes but it becomes too diluted within seconds and the image becomes very unclear. Fresh idodine dye is frequently squirted out of the tip of the catheter to maintain a clear image.
Imagine you are looking at the LAD. You squirt in some constrast, this flows out the LAD through smaller branches, through the capillaries, and eventually ends up in the right Atrium for returning to the lungs. So, the dye is always running away from you.
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976897_tn?1379171202
To make clear what im saying, watch this video of a angiogram. Notice how the artery shows up then quickly disappears when the dye flows away, then more is injected.

http://www.youtube.com/watch?v=Eoq9yrT-Ejk
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315318_tn?1353255400
Thanks for sharing  the symptoms of a leg clot. I have  muscualar pain in my hips and thighs, as mentioned earlier, however, there is no swelling. Nevertheless, I am getting a Doppler scan done this Saturday.

I hope your recovery from now as "uneventful" as the say in medical lingo.

As to your question regarding "one stent at a time" to Ed34, I believe it is a simple matter of making the most money out of a patient. Eight years ago, I made three visits to a hospital in New Jersey. First for a diagnostic angiogram and two further visits for a stent each. Two weeks ago at a different hospital (still in the NY/ NJ metro area)  they did the diagnosis and fixing (putting the stent in) at the same time. Incidentally, eight years ago, the stents failed within weeks, gave me a significant MI and need for a bypass.

Take care
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315318_tn?1353255400
I always ask the hospital for a copy of all my reports including the CD of the catheterization procedure. I also make many copies of the CD so in case I need second or third opinion, I can leave a copy with the doctor concerned. In USA, patients have right to have access to information and so hospitals are amenable to making a CD for you. I never had any problem uploading the CD on my computer and watching my own heart.

Good luck.
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976897_tn?1379171202
copies of angiograms are quite expensive in the UK. We have to pay £25 for each disc and Ive had 6 angios so far.
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315318_tn?1353255400
Hello Ed,
In UK with a more centralized health system, perhaps there is less of a need to have your own copies of  reports. i have lived greater part of my life in UK and so can compare the two systems. Here the hospitals have not charged me for the CDs or testing labs for blood work reports. However,  Drs have charged $1 per page for reports on their files. When I moved here,  the NHS  charged me 50 pounds for all 23 years worth of reports in PDF format.
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Avatar_m_tn
I had two medicated stents in 05 cause from a heartattack ,then in 07 had another heartattack caused from a blood clot in my stents..got myself  two more of the good ole cheap stents and aint had no trouble since
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976897_tn?1379171202
Cheap? are you referring to the bare metal stents as opposed to drug eluting?
After a period of time, they both carry the same risk factors for blocking.
My first stent was fitted in 2007 (feb) and was DES. I was on aspirin and plavix until June 2009 and angiograms were showing no restenosis at all. I can off plavix at that time, and by march 2011 it has formed a blockage. Now I am on plavix for life. It seems that the risk for DES blocking becomes higher in some people once plavix is stopped. They believe the problem associated with this is the drug delivery problem from the stent. If you imagine the stent as a mesh, there is a lot of blank spaces in between. None of the artery lining will be touched by the drug on the stent, only about 20%. So now in the UK they use drug eluting balloons, which obviously cover 100% of the artery lining with the drug. Then the DES is expanded into place. Early days yet, but it does seem to be showing good results.
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Avatar_f_tn
What does one actually look like>
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976897_tn?1379171202
http://www.youtube.com/watch?v=9FPapBbbS4o
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