I’ve had two DVT’s, July 2016 (age 64) and March 2019. First one (three actually) was after a 16-hour flight. Started baby aspirin as preventative, complied for a few months, then stopped. The second after a four hour computer session. Rather than put aspirin to the test again, started Pradaxa. I’m presuming ‘something’ age-related changed, that made this type of event more likely.
Was wondering what impact, if any, that rapa might have on the factors triggering a DVT.
Came up with:
Conclusions
In conclusion, we found that rapamycin stimulation induced membrane remodeling in endothelial cells. And the platelet-endothelial adhesion was enhanced in parallel. Further exploration suggested that autophagy induced by rapamycin promoted membrane remodeling, platelet-endothelial adhesion, and the concomitant thrombosis.
Not encouraging.
Also from the above study:
Hypoxia and nutrient shortage, which are apt to occur under the condition of stasis (eg. bed rest >3 days, air travel >8 hours), can induce marked upregulation of autophagy in hemocytes and endothelial cells [25,26].
Wow, potentially some free autophagy on long flights. Don’t tell the airlines, they’ll charge extra for it.
Thoughts?
PS: Protip on recognizing you have a DVT - First, you come to the realization that it feels like you have a strained calf muscle, but can’t think of any reason why that might be. Next, try walking DOWN a flight of stairs. If you find your calf EXTREMELY uncomfortable descending, but have absolutely no problem walking back up the stairs, then you may have a DVT.
I think it’s something to be concerned about. My partner had a DVT a few months ago (44F), which proceeded a lot like you described. She had ramped up weekly rapa doses to something like 5 or 6 mg over a few months. I felt responsible having encouraged her to start taking rapa with me, especially after finding similar papers as the one you cite, which were mainly in transplant patients.
But, we later learned that oral contraceptives can increase the risk of DVT in women, so that may have been the main factor. Either way, she hasn’t restarted rapa.
One option is to get d-dimer checked with Marek. After she had her DVT, and because I have been taking rapa for quite a bit longer that she has, I got it checked and my level was fine. D-dimer test was like $50 from Marek. Not cheap, but it’s a way to check. They also have some fibrinogen tests that may also indicate clotting risks, but my reading indicated d-dimer would give a decent indication.
Another option is to possibly take a low-dose blood thinner like Xarelto (rivaroxaban). Her dose was 20 mg for like 3-4 months to knock out the clot. They have much lower doses available on Indiamart for cheap.
Isn’t aspirin a longevity drug? I’ve heard taking it with a glass of water (even letting it sit in the glass beforehand) will reduce GI bleeding risk. Anyone heard that advice?
Yikes. A bit of misinformation here.
Aspirin does NOT prevent clots in all cases.
You are nuts to take Xeralto on your own. Life threatening side effects.
Sounds like cases mentioned above had reasons other than Rapa to get a clot - prolonged travel, prior DVT and BCP’s.
You need to know the indications for a D Dimer test.
Hope you got tested for genetic abnormalities.
You need to know the indications for a D Dimer test.
What does this mean? Seems like it’s a decent indicator, that you could test maybe once every 3-6 months if you’re worried:
Studies performed after a negative D-dimer for 3 months proved the high negative predictive value (NPV) of D-dimer testing together with low clinical probability (LCP) in patients with suspected VTE. Among oncology patients, D-dimer testing has the highest sensitivity and NPV in excluding VTE.
Low dose xarelto was just an idea. The low doses they have on Indiamart are in the 2 mg range, which is fairly low.
What genetic tests do you suggest to assess risk of DVT?
I would only use D Dimer in someone with a low suspicion of clot. In high risk patients you can get false negative.
If someone has multiple clots I would want to test for factor V Leiden.
Below, PCP visit notes from the second DVT. I managed to avoid the $$$ ER visit, he just prescribed the lovenox shots.
Will start treatment empirically with pradaxa (with lovenox bridge for 5 days) and check stat US. Further workup and heme dradvice or eval given that this is his second one without really great reason.
Plan: Dabigatran Etexilate (PRADAXA) 150 mg Oral Cap,
Enoxaparin (LOVENOX) 60 mg/0.6 mL SubQ Syringe,
US DUPLEX SCAN RIGHT LOWER EXTREM
Good article. Yes, there are situations where Aspirin is enough, but others in which it’s not. Best to discuss with your physician. Especially important in Atrial fib, to figure out risk factors.
The CDC does not recommend Aspirin for DVT prevention during travel.