It would help to get some clarification of her clot. You say that she has a clot in the area of the aorta. Is this partially blocking within the aorta itself ? Is it rather in the venous side the vena cava? It is common risk factor for venous clots to form while relatively less mobile recovering from surgery.
If she had an arterial side clot formation then I would think if this was in the aorta itself we are referring to a situation where there is likely some atherosclerosis and some clot on top of this. Arterial side clots are more associated with the platelet activity causing these and this is treated to help prevent recurrent formation of clots with aspirin/Plavix or sometimes both. A venous side clot is more likely associated with coagulation proteins in the blood and the risk of recurrence of this type is usually treated initially with some form of heparin and the patient started on coumadin.
Clots within major vessels may resolve to variable extent in time. This resolution of the clot is done by the body and can range from zero to 100%. More typically about 80% of clot may resolve and 20% may scar down.
With the persistence of the low blood pressure I would be concerned about the possibility that she may have had a heart attack and weakened her heart. I'm not saying that she has but it would be a potential concern. The same process that may her blood to form the clot in her aorta or vena cava may have also led to risk of clot formation within the heart's vascular system. I would think that it would be necessary to rule out a pulmonary embolism especially if her clot was in the vena cava. This is a clot in the vessel from the heart toward the lungs. In impeding the flow of blood through the system this could also have a dramatic effect to lower her blood pressure. An echocardiogram would be helpful to evaluate her heart and make sure that its function appeared normal. This plus an EKG would be good place to start as far as evaluation of her heart. The drop in her baseline BP is a potentially worrying sign. Consulting a cardiologist may help to evaluate her heart and address problem if present or provide reassurance if OK.
I hope this information helps. Further questions and details are welcome. I'll be happy to get back with you. If my answer has been helpful and to your satisfaction then please remember to press the "ACCEPT" button. thank you and Best regards,
Anthony Bray MD
Yes the high platelet count does tell me the likely risk factor of her clot formation was probably platelet activated rather than coagulation proteins. I would still prefer to check out the heart with an echocardiogram as well despite the normal EKG's. This would ensure normal contractility and no clot within the chambers of the heart as potential culprits.
The elevated platelets could in part relate to the inflammatory response associated with her surgery but her counts would be higher than expected for this factor alone. The platelet plus aspirin option which would be a bit more aggressive is probably what I would do but there may be reason that her doctor does not want this option. There is a balance of risks due to clotting vs bleeding.
I hope this helps. Further questions are welcome if you have others. Best regards,
Thank You, XXXXX XXXXX all goes well for your wife,