Subclavian DVT

Hi everyone! I have a brand new Medtronic Azure pacer,  two weeks old today.  And today, his ugly stepsister showed up in the form of a DVT in my arm. So I'm panicking a little bit. Went to the ER first thing and they confirmed what I thought.  They put me on xarelto and I went home.  I've had a big anxiety problem since all this started in Feb this year and today, it's been really bad.  

Anyone else have issues with left arm clots? How did it resolve for you?  I have a clotting disorder,  this is scaring me almost more than the pacer! 


4 Comments

Which clotting disorder?

by crustyg - 2020-09-13 03:36:17

And they put pacing leads in without providing anti-coagulation cover against clotting?

Not sure I would have let any docs do that to me.  Did you discuss this before signing the consent form?  I suspect that you would have had some sort of conversation about the best way to manage your clotting disorder for the implant.

Reading a previous post from you (AV-node damage from an ablation) I'd suggest that you change your EP team.

I think you're right to be concerned about a clot: depending on your medical history I wonder if an infusion of a tPA might be the best way forward, but you don't have a lot of time.  Sent you home?  Hmmm.

Subclavian DVT

by Gemita - 2020-09-13 03:46:54

Dear Betsy,

Firstly I am so sorry to hear about your DVT.   Xarelto (Rivaroxaban) hopefully will help to keep your blood flowing and ease your symptoms.  

I experienced an obstruction in my Subclavian vein following my pacemaker implant in May 2018.  I was already taking an anticoagulant (Edoxaban) for another condition, so my blood to my left arm/left breast kept flowing, especially as I slowly developed collateral veins around the site of the obstruction.  My left breast, left upper arm and left side of chest around my pacemaker are now laced with noticeable large veins but they have actually done a very good job of keeping my blood moving and helping me to stay relatively symptom free.  I am still getting some intermittent discomfort, but my doctors tell me from a recent scan that there is no longer evidence of any obstruction.  I hope it will soon be the same for you too.

Unfortunately due to pacemaker lead placement into a vein, damage/irritation to the vein can occur and may cause narrowing or scarring and make a DVT or other obstruction more likely.  This is becoming common now as more devices are implanted.  If your symptoms are not relieved by anticoagulation alone, I would ask to see a vascular surgeon for an opinion and ask what other treatments might be possible although these treatments are likely to be more invasive than anticoagulation treatment alone.

I hope your doctors will keep a very close eye on you to make sure you stay safe.  Any worsening symptoms (increased swelling, discolouration or pain) should be reported to your doctors quickly. Hopefully Xarelto will do its job.  Good luck Betsy

DVT

by Gemita - 2020-09-13 04:15:52

Betsy,

After reading crustyg's post above, I completely agree with his immediate concerns. 

In your shoes, I would consider going back to ER and asking whether you need additional therapy for your present acute symptoms.  You could ask to see a vascular surgeon for an opinion while you are there, if you haven't already seen one ?   I would rather err on the side of caution Betsy.  Good luck

Me too

by PacedNRunning - 2020-09-13 22:08:22

I got one about 4 mos post implant.  I noticed bulging neck veins one day looking at something else on my face.  Went to my EP and he suspected clot and sure enough after a Venogram it was a clot.  Put me on eliquis and repeated venogram 4 mos later. Still there but much smaller.  For now, we don't do anything else because my collateral veins have compensated well so far. My EP advised against venoplasty because it was too risky and possible damage the lead. Second, it will most likely reoccur because you aren't allowing collaterals to build around it.  So far,I have minimal arm swelling and doing well. I no longer take eliquis.

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