November 29, 2015

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Blood Clots

Blood Clots

How can blood clots be prevented?

Prevention is key in thrombosis or clot formation.

Arterial thrombosis

  • For arterial thrombosis, the most likely precipitating event is a plaque rupture with clot formation in the artery.
  • Minimizing the risk of vascular disease requires life-long attention to the risk factors that lead to plaque buildup and "hardening" of the arteries.
  • Blood pressure and cholesterol control, diabetes management, and refraining from smoking all minimize the risk of arterial disease.
  • Although family history is an important risk factor, one needs to be even more vigilant about the other risk factors if there is a family history of early heart attack or stroke.

Deep vein thrombosis

The main risk factor for deep vein thrombosis risks is immobilization. It is important to move around routinely so that blood can circulate in the venous system. On long trips, it is recommended to get out of the car every couple of hours and in an airplane routinely get up and stretch.

Physicians and nurses work hard at getting people moving after surgery or while in the hospital for medical conditions. The low molecular weight heparin known as enoxaparin (Lovenox) can also be used in low doses to prevent clot formation. Patients are often given tight stockings to promote blood return from the legs and prevent pooling of blood.

In patients with atrial fibrillation (AFib), warfarin (Coumadin) was traditionally used to prevent clot formation and minimize the risk of embolus and stroke. Newer medications have been developed that prevent blood clot formation similar to warfarin and have been approved for use in patients with atrial fibrillation. These medications include apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and edoxaban (Savaysa). These newer drugs have advantages of reduced susceptibility to diet and drug interactions and convenience (lack of need for routine blood testing of the international normalized ratio or INR, as is required for warfarin therapy). Unfortunately, there is no medication available in the United States to reverse the anticoagulation action of these medications, should that need arise.

The decision as to which medication to use for atrial fibrillation depends upon the clinical situation. Aspirin may also be an appropriate drug to use in low risk patients. That risk may be measured by the CHADS2 scoring system for atrial fibrillation that assigns a score for potential stroke based on age and history of high blood pressure, congestive heart failure, diabetes and previous stroke or TIA history. Continue Reading

Reviewed on 2/27/2015
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