The Answer: You ask two important questions: Why do people sometimes develop thrombosis or abnormal blood clots in arm veins? And how does one find a doctor who specializes in thrombosis?

With respect to your specific circumstances, Dr. Geerts, a thrombosis specialist at Sunnybrook Health Sciences Centre, stated that arm DVT and blacking out spells are almost never directly related. These are nearly always related to separate causes.

Arm DVT is usually not a dangerous condition and the symptoms are usually not severe. Arm DVT results in swelling and discomfort of the arm sometimes with a dusky skin color. The cause of arm DVTs can usually be determined, according to Dr. Geerts, with the overwhelming majority being due to the use of a central venous line or a pacemaker inserted into an arm vein. The second relatively common cause of arm DVT is called thoracic outlet syndrome which occurs because of compression of the arm vein near the shoulder as it passes through the thoracic outlet, the space between the upper ribs and the collarbone.

Dr. William Geerts

An arm DVT is treated with anticoagulants given anywhere from a few weeks to indefinitely depending on the specific patient’s circumstances. “There is no evidence that aspirin provides any protection against recurrent arm DVT,” according to Dr. Geerts “and I do not use aspirin for this purpose.” “Although there are no tests that can be done to predict your risk of another arm clot,” stated Dr. Geerts, “it is important to try to determine the cause of the arm clot since this may influence the treatment duration.”

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The Answer: A cold or flu can increase the effect of your warfarin and may warrant an adjustment in the dose. The best thing to do is to call the clinic and describe your symptoms. Clinic staff may tell you to come to hospital and have a blood tested sooner than scheduled. Depending on the severity of your illness, the staff may also suggest the warfarin be changed.

“Although anticoagulants are life-saving, they’re potentially dangerous drugs given for dangerous diseases,” said Dr. Bill Geerts, a thrombosis specialist. “Over the age of 70, about 10 per cent of people have atrial fibrillation and most of these patients should be taking an anticoagulant.”

Not every patient who could benefit from the drug receives it. In fact, it requires so much monitoring and effort, that some patients are not given the option. Others are put on aspirin, even though, as Dr. Geerts points out, it is much less effective at preventing stroke in atrial fibrillation, a disorder of the heart’s electrical system.

Anticoagulants include heparin, low molecular weight heparin, warfarin and new oral anticoagulants dabigatran and rivaroxaban. There are two groups of patients typically prescribed them: those with atrial fibrillation and patients with deep vein thrombosis/pulmonary embolism – abnormal blood clots that develop in a leg vein or travel to the lung.

Anticoagulants should also be prescribed prophylactically to many surgical and medical patients in hospitals – but that isn’t always the case.

In fact, Dr. Geerts estimates more than 20,000 Canadians die each year after being struck down by these silent killers. [This rate is an extrapolation based on data from the United States].

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