Blood Thinners

[contactsiri]

Im scared to start them and the risks involved. I found this on Claude AI. I attached Pic of my collateral veins. Thank you @Isaiah_40_31 for that. I should state my doctor knows nothing about Eagle Syndrome and he’ll throw anything at me so I have to be careful. I’m also on 15 mg of meloxicam a day for head pain. I don’t want to damage liver and kidneys with that and more medications if i don’t have to.

There is no blood thinner made specifically for collateral veins. Collaterals are detours the body builds around a blocked or narrowed main vein. Whether a blood thinner is needed depends on what caused the blockage and on bleeding risk. Chronic DVT is a common cause. Long-standing blockage leads the body to form collateral circulation to compensate.

When a clot is the cause, the evidence favors a newer oral blood thinner (DOAC) over warfarin. CHEST guidelines recommend any of the four DOACs over warfarin for long-term treatment in patients without cancer. Apixaban (Eliquis) has the strongest safety record. A large real-world study found apixaban cut overall bleeding risk roughly in half compared with warfarin at six months. Protection against new clots was similar. In trials apixaban also caused less bleeding than the other DOACs.

Situations where apixaban may not be the right choice:

• Antiphospholipid Syndrome usually calls for warfarin instead of a DOAC.
• Severe kidney disease or certain drug interactions can change the pick.
• Collaterals caused by liver-related pressure (varices) can bleed, so blood thinners need extra caution.
• A vein narrowed by compression or scarring with no clot may not need a blood thinner at all.

Well-formed collaterals in a stable patient can allow conservative treatment with ongoing anticoagulation rather than a procedure. The key question for the treating doctor is what is blocking the main vein and whether an active clot is present. That answer decides whether a blood thinner is needed and which one.

Sources:
[Extensive Collateral Venous Circulation in Chronic DVT (PMC)]( Extensive Collateral Venous Circulation and Anatomic Remodeling in Chronic Deep Vein Thrombosis - PMC )
[Case Reports in Cardiology abstract (HCA Healthcare)]( "Extensive Collateral Venous Circulation and Anatomic Remodeling in Chr" by Demi Curbelo, Ian Lancaster et al. )
[Apixaban vs warfarin bleeding risk study (Becaris)](https://becarispublishing.com/doi/suppl/10.57264/cer-2024-0207)
[ClinCalc on CHEST guidelines and DOAC choice]( Cardiology - ClinCalc.com )
[ClinCalc on apixaban bleeding data](Apixaban Should Be the Preferred DOAC for Venous Thromboembolism and Nonvalvular Atrial Fibrillation - ClinCalc.com)

[Jules]

Thanks for that info @contactsiri , appreciate the work you’ve put in to researching this when you’re feeling rough
There have been a few different meds which have been prescribed for members with IJV compression, some people have done quite well, others feel it’s not helped, so it’s very much an individual decision.
The other meds commonly used are Plavix, Brillinta, Xarelto, Diamox, and aspirin… I don’t know about any side effects or safety concerns with those…
If you are worried about safety, some members have used supplements like Creatine, Trimetazidine & Citicoline, but obviously people need to check up on any interactions with medication they’re already on…

[contactsiri]

Thank you @Jules . As always your insights are deeply appreciated.

[Isaiah_40_31]

@contactsiri - I feel like the information you presented is more relative to long-term blood thinner usage, though there is always a bleeding risk for anyone on a blood thinner. Most of our members who’ve tried one of the blood thinners @Jules listed, & had good results, have only taken it for a few months as it was not needed once the IJV(s) are decompressed. It’s my personal opinion that short-term use of an Rx blood thinner is less risky than taking it over the long term.

I believe the blood thinners mentioned all have “antidotes” i.e. if bleeding either internally or externally occurs, there are medications such as prothrombin complex concentrate (PCC) that can be given which quickly reverse the anticoagulant effect.