Coagulation and clotting are synonyms for the ubiquitous, normal process by which blood clots, forming a sticky, gelatinous material, which adheres to and blocks rents and tears in blood vessels following injury, preventing blood loss. Thus, clotting is a vital physiological process that allows the body to reduce or stop bleeding from cuts and injuries. Further, apart from injuries to vessels, there are two other causes of clotting in the body. These two causes are stasis (stagnation) and hypercoagulability of the blood. The risk of clotting in a blood vessel increases precipitously with additional risk factors. Stagnation of blood in leg veins occurs with prolonged debility, prolonged bed rest and travel. However, in a hypercoagulability state, blood clots too easily, often in otherwise normal individuals for no apparent reason. Often, an underlying cause comes to light. Predisposing factors include taking contraceptive pills or testosterone supplements. This hypercoagulable state or thrombophilia (“clot-loving”) can result from a host of other causes. Having an injury to a leg vein by a trivial blow, stasis during a long flight or car journey and hypercoagulability—perhaps from smoking, is sufficient to result in a significant deep venous thrombosis (DVT).
What Causes Clotting?
There are twelve clotting factors in the blood, which work in combinations and in concert to form a clot—much like a falling set of domino chips. Clotting can be initiated when the blood comes in contact with a foreign body, such as a newly implanted heart valve or when the platelets are exposed to tissue juice of an injured vessel. Both routes end up activating factor ten (factor X), starting the clotting cascade. Happily, the plasminogen system is also often activated to limit the extent of the clot and tailor it to need. However, a hypercoagulability state simply increases the sensitivity of the clotting process manifold in response to trivial triggers that would not otherwise initiate clotting.
What Causes Hypercoagulable States?
Hypercoagulability can be genetic, and a good example is inheriting a mutant gene (or developing one) called factor V Leiden thrombophilia. It may also arise in connection with conditions or entities like cancer, obesity, recent surgery, hormone supplements and medications, to name but a few. Recovery from major surgery (that the body interprets as injury) can be a problem because it combines a hypercoagulable state, invoked by surgery, with possible stasis from prolonged confinement to bed. Hence, most modern surgical facilities take adequate precautions during and following major surgery.
How Is It Diagnosed?
A patient’s medical history may lead a physician to suspect hypercoagulability. Pointers in the history may include personal or familial clots or strokes at a young age, especially in unusual sites, as well as recurring clots. When any of these elements are present in the history, a physician may screen for thrombophilia with one of several tests, including partial thromboplastin time (PTT), prothrombin time (PT), complete blood count (CBC), fibrinogen level and fibrinogen degradation products (FDP).
What Are The Treatment Options?
If a physician determines that excessive clotting is taking place or may be a problem, then the condition may be treated either prophylactically or therapeutically with an anticoagulant medication like warfarin (Coumadin), regular heparin, a low molecular weight heparin or any of several newer agents. These medications are used to decrease the blood’s tendency to clot, which should prevent abnormal clots forming or increasing. Unfortunately, taking anticoagulants can make people more susceptible to bruising and bleeding. Hence, it is advisable for people taking anticoagulants to wear a medical identification necklace or bracelet in case of emergency. If you were to be involved in a car accident, for instance, paramedics would need to know about the medication you are taking.
While coagulation is an essential function of the blood, a hypercoagulable state, if untreated, can lead to many kinds of serious medical issues, including heart attacks, strokes, deep venous thrombosis (DVT), pulmonary embolism, arterial embolism or thrombosis leading to loss of limb.
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