Should husband double-up on low dose aspirin prior to long flights?

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PJmomrunner

Well-known member
Joined
Apr 10, 2005
Messages
1,726
Location
SW Michigan
You may recall that my husband broke his pelvis on the 4th of July. He's doing very well, but he's still non-weight-bearing on his right leg for another 4 weeks. Because of this he's at risk for blood clots and wears a prescription support sock and takes low dose aspirin. He will be travelling internationally a lot in the coming weeks for the first time in his impaired state and I'm concerned that these long flights further increase his risk of DVT. He has promised to get up and move at least once every hour, but I'm not sure he'll find that's really possible given that he's on crutches and planes can be pretty unstable even if one is not on crutches.

So, what do you think? Should he take more aspirin for, say, two days prior to each flight?
 
The latest guidelines for antithrombotic therapy published about two years ago in the medical journal Chest recommend that aspirin not be used in the prevention of DVT because it is ineffective.

The V in DVT stands for vein. Aspirin is more effective in preventing clots in arteries not veins. He should be on warfarin for clot prevention in such a major injury.

If he were to die from a clot, it would be a relatively simple matter for you to win a huge lawsuit. The use of aspirin in this situation is almost indefensible.
 
Yikes! :eek: Thanks for the rapid response, Al. He was on Lovenox for two weeks--in the beginning. Can you point me to a journal article that I can share with his doctor when requesting ACT for him? Kinda glad I asked :rolleyes: .
 
I've looked at a handful of abstracts on the subject and pondered things whilst doing that and now I have a couple other things: My uncle, who had a total hip replacement shortly after my husband had his surgery, is on ACT. Shouldn't his and my husband's risks be comparable? (I'm guessing you think so, Al) And...my husband's a vegetarian, so he probably eats more vitamin K-rich food than the average person. Does this also increase risk? Hubby leaves Saturday...should I be on the phone raisin' some he__ with his doctor? (we did discuss this at his last appt.--doc felt low dose aspirin was enough)
 
Looks to be I need a subscription to get to the heart of the info. I can't find anymore then you have so far and that's not saying much on ACT, just grades.
 
YEP, get on the phone to his DR. ASAP.

He may even want to get a few LOVENOX injectors to tide him over until his INR gets up to the theraputic range which can take several days, assuming the DR gives him an RX. Get moving, not much time before takeoff!

'AL Capshaw'
 
The statement is, "We recommend against the use of aspirin alone as thromboprophylaxis for any patient group." The level of evidence to back this up is Grade 1A. That is as good as the evidence gets.

Reference: Chest 2004;126:338S-400S

The argument that the orthopedic docs give is that this is from Chest physicians andf that the orthopedic literature says something else. The people on the Chest committee with whom I have talked say that the counter to that is that orthopods were included in this decision.

The other thing is that this comes from the most convincing type of evidence. To refute that someone needs to be able to quote a study of similar relevance, not just some opinion. Opinion is regarded as the weakest form of evidence - when nothing more convincing is avaiolable.
 
Well...

Well...

I called my husband's internist and left a message and called his surgeon's office and spoke to his nurse and she pretty immediately said that my husband should be on Lovenox until he is weight-bearing and that that has been the protocol for at least a couple of years. She said she would talk to the surgeon and get back to me. She went to the surgeon and he told her that he disagreed with the expert I talked to online, so she went to bat for my husband's well-being and told him what she knew. He agreed to prescribe Lovenox until my husband's next appointment in four weeks (at which time he should get the okay to begin weight-bearing).

The internest just called back and his opinion (before I told him the issue had essentially been resolved) was that my husband should be on Lovenox or coumadin until he is weight bearing, but he's going to talk with his anticoagulation expert just to be sure and get back to me. He also stated that if the decision has been made that anticoagulation is needed, aspirin is not an acceptable choice. He agreed that it's probably not a good idea to start coumadin two days before heading off to China, so Lovenox is probably the way to go. I'll let you know if his ACT expert has anything to add; I suspect it's a closed case.

In the meantime...my husband has no idea any of this has transpired! He's going to love my telling him he's gotta bring a bunch of syringes aboard his upcoming flights and poke himself in the belly every day! :D

Thanks a million, Al. Add my husband to the long list of those whose lives may just have been saved by your sage advice!
 
Going to CHINA?

With 60 Lovenox Syringes? (At $100 a shot!)

(Twice a day, 12 hours apart until INR is stable or continuously if NO Coumadin is being taken ....
WHERE is the nearest (Chinese) Coumadin Clinic ???)

My (former) PCP told me to take ALL my medications as Carry-On should I travel by air as all her vitamins and supplements were confiscated from her luggage on a DOMESTIC trip. Good Luck with the NO LIQUIDS RULE.
(Don't forget the $100 / shot and the issue of what he
will do in China if he gets there with NO Lovenox!)

Frankly, I would seriously consider rescheduling the trip to China given his condition!

I'm sure this trip to China is IMPORTANT...
so is his LIFE...

Tough Choice.

'AL Capshaw'
 
More Questions

More Questions

1 - Did he self administer the Lovenox injections during his first two weeks? If not, will he be able to set up an appointment to learn how to do so?

2 - Does he really think he can travel all over Asia for the next 4 weeks on crutches without putting any weight / stress on his injured pelvis?

3 - Are his Doctors (and especially Surgeon) aware that he intends to hobble all over Asia on Crutches in the hope that he won't put any weight on his healing Pelvis?

4 - Have you asked the AIRLINE about how he can take / carry 60 LIQUID filled Lovenox Injectors without having them confiscated by Security Agents?

5 - Has he been released from the Surgeon's care?
If not, did the surgeon approve this travel?
If not, will his INSURANCE be void in the event
he has a stroke or other medical emergency?
If so, will his company cover any medical care he
needs, up to and including Lifetime Long Term Care
in the event he has a debilitating STROKE?

Just a few things to consider before he departs Saturday.

And if he still insists on going, does he have a First Class seat or a seat that will allow him extra room to extend his legs?

'AL Capshaw'
 
Lots o' good questions, AL...

Lots o' good questions, AL...

1 - Did he self administer the Lovenox injections during his first two weeks? If not, will he be able to set up an appointment to learn how to do so? No. I did, but he was taught too and he can handle it. He only has to take one shot a day...maybe dosing is different for different applications like it is for Coumadin?

2 - Does he really think he can travel all over Asia for the next 4 weeks on crutches without putting any weight / stress on his injured pelvis? He'll only be in China (yes, all over though) for a week and he's been on crutches already for five weeks. (He will be in Europe for a few days, then home for a few days and then in South America for a week.) He fractured three parts of his pelvis. Interestingly, he is okay supporting his weight with his left leg, as the fractures are on the right side and all associated with his acetabulum (the hip socket) and his pubic bone, so sitting is no problem and he has no (and never has had) pelvic positional restrictions. He won't need to do anything there that he hasn't already been doing here.

3 - Are his Doctors (and especially Surgeon) aware that he intends to hobble all over Asia on Crutches in the hope that he won't put any weight on his healing Pelvis?Yes, they are aware. He stepped down once on his right foot (on the way back from his two-month doctor's appointment! He made the mistake of wearing a shoe on his right foot for the first time. He won't make that mistake again--I'm only packing left shoes!:D).

4 - Have you asked the AIRLINE about how he can take / carry 60 LIQUID filled Lovenox Injectors without having them confiscated by Security Agents?
No, I haven't, but I sure will. Our experience thus far has been that there are exceptions for prescription medicine and small containers of saline solution (and baby food/formula), at least on domestic travel. International travel may be different, so I'll definitely check it out. He won't need to carry on the Lovenox, though, so it shouldn't be a problem.
5 - Has he been released from the Surgeon's care? No. I don't understand the significance of this one. Can you explain?
If not, did the surgeon approve this travel?Yes.
If not, will his INSURANCE be void in the event
he has a stroke or other medical emergency?His is an international job with an international corporation, so his coverage is international.
If so, will his company cover any medical care he
needs, up to and including Lifetime Long Term Care
in the event he has a debilitating STROKE?I sure hope we never need to find out! But we're pretty well set.

Just a few things to consider before he departs Saturday.

Traveling is a big part of what he does. He takes it in stride. As long as he has that Lovenox, he'll be fine. I'll let you know what I find out about regulations for traveling with that. Oh, and he'll travel Business Class, so he'll be able to stretch out and move around a bit more easily, but I do still worry about the moving around part (less, though, now that we've got that Lovenox).
 
Check with the Coumadin Nurse (and Al Lodwick!) about only taking ONE Lovenox shot per day.

When I did my Bridging with Lovenox before and after a Colonoscopy, my CRNP at the Coumadin Clinic scheduled me for TWICE a day. I was of the opinion that the AC effect of Lovenox was pretty well gone after 12 hours. Again, check this out.

I would be concerned about putting the Lovenox Syringes in Checked Luggage. As I mentioned in a previous post, my former PCP had her VITAMINS and MINERALS confiscated from Checked Luggage on a DOMESTIC flight!

The question about being released by the Surgeon carries legal implications that may affect (nullify) insurance coverage if he engages in any activity against 'Doctor's orders' (e.g. NO Driving for 6 weeks after OHS, or NO weight bearing on the affected leg / hip, etc.)

'AL Capshaw'
 
It is truly amazing and humbling what the internet makes possible. I don't see that I have any special gift, I just happen to be at the center of where information is passed.

The long-timers on here will remember that I have quoted my friend Bert Marian, "We are called/sent to be where we are needed the most."
 
I have looked into dosage and duration of treatment with Low Molecular Weight Heparin for pelvic fractures and really haven't found a lot that is specific to this precise situation. However, after reading a lot of study abstracts on the internet, and particularly on http://www.lifestages.com/health/venous.html, I believe that my husband will be adequately covered by a combination of one 40mg dose of Lovenox per day and compression stockings.

Many thanks again to Al Lodwick for putting himself "at the center of where information is passed" and to AL for his thorough trouble-shooting effort.
 
In rfeal-life few people wear the compression stockings - too hard to get on and off.
 
In rfeal-life few people wear the compression stockings - too hard to get on and off.

If there's anything my wonderful husband is, it is one of the few! He has faithfully worn his compression stockings every day since surgery. He is a 100% compliant patient, thankfully. Of course, he is probably decades younger than the average patient with a similar injury and consequently doesn't have much difficulty getting those socks on and off. Now, in the first couple weeks when I was the one taking them on and off, it was a different story--pretty darn difficult for me--but I did it.
 
PJmomrunner said:
I have looked into dosage and duration of treatment with Low Molecular Weight Heparin for pelvic fractures and really haven't found a lot that is specific to this precise situation. However, after reading a lot of study abstracts on the internet, and particularly on http://www.lifestages.com/health/venous.html, I believe that my husband will be adequately covered by a combination of one 40mg dose of Lovenox per day and compression stockings.

Many thanks again to Al Lodwick for putting himself "at the center of where information is passed" and to AL for his thorough trouble-shooting effort.

PJ -

You might have more luck looking for information under "Joint Replacement" and especially "Hip Replacement" which would probably be the more applicable.

Lovenox dosing is linearly related to weight. As a Mechanical Valve recipient, weighing roughly 200 lbs, my dose was 100 mg every 12 hours. I was told to take my LAST dose 24 hour prior to my procedure (and then resume the night following the procedure). From that schedule, I would infer (*assume*) that the anti-coagulation effect of Lovenox would be ZERO after 24 hours.

As a 'valver', 40 mg every 24 hours seems like a MINISCULE dose for an adult male, but maybe that's enough for joint replacement. I have NO idea how they compare. Check with your (most available) 'anti-coagulation expert'.

'AL Capshaw'
 
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