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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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My wife Caucasian female, 5ft 7in 158 lbs age 65. Diagnosed

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My wife Caucasian female, 5ft 7in 158 lbs age 65. Diagnosed with High BP 15 yrs ago and placed on meds. BP controlled. 3/31/10 wife had spinal surgery, degenerative disc disease. BP low while in hospital so meds discontinued. She was coming along well until 4/22/10---stomache pain, vomiting, diarrhea and dizziness. Taken to ER----dehydration and blood clot found in aortic region of abdomen. Referred to GP who consulted hematologists and radiologists. Nothing can be done about clot--monitor and take two aspirin daily. BP is still low when standing or walking (in home) 78/58 although normal while sitting or laying down 118/75. Still experiencing dizziness and weakness--no longer dehydrated. GP says "do not worry about these two conditions--I am not worried". Sorry to say that I am extremely worried and need your input on conditions and what followup I should attempt. I really do need your help--PLEASE. Thank You In Advance---Alan F. Varan
Submitted: 7 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 7 years ago.


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

Customer: replied 7 years ago.
The Blood Clot is in the Aortic Region of the Abdomen----She has had three EKG's and all are normal. In your answer you did mention platelet activity. I forgot to mention in my question that last week her platelet count was elevated to 1.2 million---where her norm is between 400 and 500K----This week her platelet count is down to 700K. Does this additional information assist you in any way? Alan Varan
Expert:  Anthony Bray, MD replied 7 years ago.

Hello again!

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,

Anthony Bray MD

Customer: replied 7 years ago.
Thank You Doctor for your time. Your answer has not relieved me of my fears but I do accept your answer and appreciate the time you have spent on this reply. I will have her see a cardiologist as quickly as possible. Thank You once again Alan Varan
Expert:  Anthony Bray, MD replied 7 years ago.

Thank You, ***** ***** all goes well for your wife,

Best Wishes,

Anthony Bray MD

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