The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca
The Question: I am a 66-year-old male in good physical condition with great annual check-up results and not on any medication. Yet, 7 months ago, I was hospitalized after blacking out twice and was diagnosed with a DVT in the left arm. Following 6 months of anticoagulation with warfarin, my hematologist recommended I stop taking it. Since no cause for my arm DVT was established, my risk of another DVT remains a great concern to me. How does one find and consult medical professionals who are experts in Thrombosis? My GP has had difficulty even finding such an expert to refer me to.
The Answer: You ask two important questions: Why do people sometimes develop thrombosis or abnormal blood clots in arm veins? And how does one find a doctor who specializes in thrombosis?
With respect to your specific circumstances, Dr. Geerts, a thrombosis specialist at Sunnybrook Health Sciences Centre, stated that arm DVT and blacking out spells are almost never directly related. These are nearly always related to separate causes.
Arm DVT is usually not a dangerous condition and the symptoms are usually not severe. Arm DVT results in swelling and discomfort of the arm sometimes with a dusky skin color. The cause of arm DVTs can usually be determined, according to Dr. Geerts, with the overwhelming majority being due to the use of a central venous line or a pacemaker inserted into an arm vein. The second relatively common cause of arm DVT is called thoracic outlet syndrome which occurs because of compression of the arm vein near the shoulder as it passes through the thoracic outlet, the space between the upper ribs and the collarbone.
An arm DVT is treated with anticoagulants given anywhere from a few weeks to indefinitely depending on the specific patient’s circumstances. “There is no evidence that aspirin provides any protection against recurrent arm DVT,” according to Dr. Geerts “and I do not use aspirin for this purpose.” “Although there are no tests that can be done to predict your risk of another arm clot,” stated Dr. Geerts, “it is important to try to determine the cause of the arm clot since this may influence the treatment duration.”
In response to your second question, there are only 30-50 physicians in Canada who specialize in Thrombosis. There are one or more thrombosis specialists associated with most of the medical schools in the country. If you are living in Ontario, your family doctor can FAX a referral to the Sunnybrook Thrombosis Clinic at 416-480-5153.
There are also a number of web sites related to thrombosis, including Lifeblood, the UK thrombosis web site, National Blood Clot Alliance and Vascular Disease Foundation. Web site links on all these organizations are at the bottom of this email.
Thrombosis Canada is an organization of Canadian health professionals dedicated to the prevention and treatment of thrombotic disorders as well as to providing education to other health professionals, patients and the public. A completely revised Thrombosis Canada website will be launched in the spring of 2013.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.