Clot causes feeling of heaviness

Dear Dr. Roach: I am a 62-year-old female. In January 2018 I was diagnosed with acute myeloid leukemia. I received a stem cell transplant and am in remission. Everything was progressing fairly normally until six months post-transplant, when I suddenly developed a blood clot in my right leg. I was on Eliquis for nine months, Pradaxa for five months and have just been switched to Xarelto. The results of my ultrasound last week showed “unchanged clot occluding the femoral vein down to the veins in the calf.”

I can’t understand why the clot won’t dissolve. I was told clots usually take three to six months to dissolve. I inquired about a surgical procedure that had been mentioned to remove it, but was told it wouldn’t be safe. Later I was told that since the clot was in the vein, they can’t do the surgical procedure. My doctor talked with a colleague who specializes in clotting disorders, and he said I would need long-term anticoagulants. If I’m on my feet for more than 30 minutes, my foot and ankle area get a numb, heavy feeling. Do you think there is anything else that can be done? — S.T.

Blood clots don’t really dissolve, but they do organize and usually develop channels for the blood to flow through again. Sometimes the vessels are permanently blocked and the blood finds other ways to flow. This is called collateral circulation. In your case, the symptoms of that backup are the heavy feeling you get. Swelling would be common.

Although procedures to reopen clotted veins do exist, they are generally used for people with severe symptoms, such as nonhealing ulcers. This would also include people who have not responded to conservative treatment, including support stockings and elevating the leg above the heart.