Bloodclots

What is a blood clot?

Basically, a blood clot (also known as a Thrombis) is the result of the coagulation process in the body which seeks to stop bleeding.  It is a natural and necessary process in the human body.  Blood clots cause problems when they do unnecessary clotting and over react to internal trauma in the body.

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What causes blood clots?

Blood clots can be caused by many things.   The following are the most common that I found in my research.

• Hereditary factors causing extra and excessive clotting of blood vessels such as Factor V Leiden
  
• Trauma and damage to the inside of blood vessels caused by accidents or surgery
  
• Prolonged sitting or inactivity which causes changes to or blockage of normal blood flows
• Obesity
  
• Cardiac problems (heart attack, heart failure)
  
• Pregnanacy and childbirth
  
• Flying at high altitudes
  
• Hormone therapy (HRT)
  
• Birth control pills 
• Smoking
  
• Disseminated intravascular coagulation (DIC), a condition where blood clotting occurs abnormally
  

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What are the symptoms?

Here are some of the symptoms of blood clots (I am sure this is not a full list of what might have been encountered).

PE (Pulomary Embolisms - blood clots in the lungs)

• Lack of power and endurance during exercise
  
• Single dry cough (especially after laying down)
• Cramping and spasms in the rib and abdoninal area which worsens with each breath (referred to as pleuritic chest pain)
• Inability to lay down without becoming winded (you may have to sleep sitting up or in a recliner chair)

DVT (Deep Venous Thrombosis - blood clots in the legs)

• Swelling in the thigh or calf
  
• Gradual onset of pain (may feel like the stiff joints in the hip or knee area)
  
• Redness or darkening of the skin
  
• Warmth to the touch
  
• Pain when moving the hip or knee joint
  
• Leg cramps
• Lack of mobility in the leg joints
  
• Some people do not feel any symptoms at all from the DVT
  

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How are blood clots diagnosed?

Diagnosis may be quick (if you have already had blood clots before) or may take longer.  This, of course, depends on the doctor's level of knowlege and the hospital you are in.  Here are some the diagnostic tools that might be used during diagnosis.


• Electrocardiogram (ECG)
•  X-Ray
• Nuclear medicine scan
• Magnetic resonance imaging (MRI)
  
• Computed tomography (CT)
• Ultrasound on the legs or heart (echocardiogram)
• Angiogram or Venogram
• Genetic test (e.g. for Factor V Leiden)

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What treatments are available?

From what I have experienced, the only real treatment for blood clots is blood thinners (also known as anticoagulants). The following are the most common that I have encountered.

• Fragmin. This comes in the form of an syringe (injectable) and is fast acting. This is usually given in the hospital for around 5-7 days or may also be given at home by the patient themselves
• Coumadin (Warfarin). This is slow acting (which is why the Fragmin is given first) and overlaps the Fragmin injections.  This may be for 6 months after the first occurance of blood clots.   Move recently, people with first time blood clots may be put on Warfarin permanently.
  
• Heparin. This might be used only in a hospital setting or in emergency situations.

All of the cases above will involve taking a periodic blood sample to check the INR (Internation Normalized Ratio). The ratio should be between 2 and 3. The blood sample will usually be taken several times a week in the beginning and when the optimal number is reached (between 2 and 3), the blood samples can be take once a month by a labratory with the results being sent to your doctor.

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What is the prognosis?


There seem to be four possible outcomes to bloodclots.  They are listed below.


• The blood clot could travel around the body perhaps arriving in or going through the heart to the lungs (known as Embolization)
•  The clot could propogate toward the heart (known as Propagation)
•   The blood clot could dissolve and break up in the body and not cause any further problems (known as  dissolution).   This is what the blood thinners attempt to do
  
•  The blood clot could stay where it is and develop small channels to reinstate blood flow through the clot (known as recanalization or organization)

The length of time it takes to recover depends on the type, size, location and prognosis above. Both my PE and DVT took a few months to recover from to get back to feeing 'normal'.

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What type of doctor do I need?

This is a very important question.  Many types of doctors may be involved in a bloodclot diagnosis.  In the end only one (probably your family doctor) will be the one to prescribe blood thinners on an ongoing basis.   Any doctor can prescribe blood thinners so you do not have to settle for a 'specialist' doctor.   My experience has been that 'specialists' were the worst doctors I could have ever had.   Do not settle for any doctor that belittles your condition or questions if you even have it in the first place even after you have been diagnosed.  You will have many choices.   To get blood thinners, you can use walk in medical clinics to refill the perscriptions.  This has been a very good experience for me since I only needed prescriptions refilled (the only treatment is blood thinners anyway).  The following types of doctors might be part of the diagnonsis but will not be needed on an ongoing basis.

Hemotologist
Doctor of Internal medicine
Family Doctor