Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a calf DVT in my paired perineal veins about 4 months ago. This was probably the result of dropping a heavy object on my foot. I did not have any pain in my calf, but foot pain just foot bruising and pain that would not let up (with no fracture). I was out on Eliquis for 3 months and had a follow up ultrasound a month ago and I was clot free so I came off blood thinners.
Since coming off, that leg has been tight and the last week or so I am having light spasms/twitching throughout the day in various spots below the knee in that leg. There is no warmth, swelling or redness or any signs today but I am worried something might be wrong. Should a slightly “tight” and uncomfortable leg with daily bubbling or twitching be a concern or should I go to an ER? Trying to avoid if possible with the COVID situation.
33/male 5’9 215 lbs. On blood pressure medicine and Allopurinol + .6 Colchicine daily for the last 5 months for a recent gout diagnosis.
Hello,
Welcome to icliniq.com.
This slight tightness or twitching is not classically indicative of development of DVT. This may be related to past injury or after effect of DVT. Also, there is no provoking factor now for DVT and there are no classical symptoms of DVT. I guess, provocation last time was immobility due to trauma, so such factor is not there now to provoke it.
You also mentioned that there were no classical symptoms like calf pain or swelling, during last diagnosis, so what lead to the diagnosis of DVT? Was it a routine screening or suspicion due to excessive bruising over the foot? So, there is no point in support of DVT, but since you did not have any classical symptoms of DVT last time as well, so we cannot be sure in ruling it out based on symptoms only. So, if your symptoms are significant then better to go for an ultrasound. This ultrasound would additionally give confirmation regarding no redevelopment after being off eliquis confirming it was a provoked DVT only and no long term treatment is necessary.
Patient's Query
Thank you doctor,
The last time I had major bruising under my toes on the top of my foot in the metatarsal area. Two weeks with no fracture and extreme pain led my orthopedic to send me to a ultrasound “just to rule out a blood clot” . He was shocked I had one, but said it was “low risk”. My options are ER or doctors appointment on wednesday. I also still have eliquis left from a few months back. I known I have to make this decision on my own, but do you think it warrants an ER visit?
Hello,
Welcome back to icliniq.com.
So considering the overall scenario, it is unlikely to be a DVT, so in my opinion, it is not an emergency and visit on Wednesday would do. Even I do not think it is necessary to have Eliquis empirically. And in rarer scenarios, even if turned out to be DVT, it would be low risk again. All the best.
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Cardiology
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