BLOOD CLOTS
Definition
A blood clot is a mass of blood cells and blood components that form to stop the bleeding that occurs when a blood vessel is injured. When a blood vessel is broken, platelets in the blood become sticky and clump together at the site of the injury. They begin to form a mass to stop the flow of blood.
Description
Clotting is the body's normal response to a bleeding injury. It is a necessary function to prevent a person from losing too much blood. Most blood clots dissolve back into the blood when the body has healed the vessel. Blood clots, however, can be potentially dangerous if they occur within healthy blood vessels, or if they do not dissolve when their work is done. A thrombus is a blood clot that forms along the wall of the heart or a blood vessel. This type of clot can slow blood flow, and if the clot becomes large enough, it may stop the flow of blood in the vessel. An embolus is a clot that forms in one area of the body, travels through the bloodstream, and lodges in another vessel in the body. Emboli are less common and more dangerous, because they can cause a sudden blockage in blood flow (embolism), which could be fatal. An embolism occurring in an artery will block blood flow to an organ or tissue, and could cause tissue damage or death.
An embolism in:
- a cerebral (brain) artery can cause a stroke
- a coronary artery can cause a heart attack
- a pulmonary (lung) artery can cause shortness of breath or death
- a retinal artery can cause sudden blindness in one eye
- an artery supplying blood to a limb can cause tissue damage and possibly gangrene
- any artery leading to an organ can cause loss of that organ's function
Causes & Symptoms
There are several factors that contribute to the formation of blood clots. Phlebitis is a condition that may increase abnormal blood clot formation. Blood diseases or other conditions—especially inflammation—that alter the quality of the blood can also affect clot formation. Plaque formation in the arteries (atherosclerosis) and damaged blood vessels both increase the chance of blood clots because they slow blood flow and provide a place for platelets to collect and form a clot. Genetic factors also play a role in tendency to form blood clots. Diet can have an effect on clot formation, as well. Cholesterol and saturated fats, which are also implicated in atherosclerosis, can contribute to clot formation. People whose diets are low in essential fatty acids,
vegetables, and fish, and who do not take in proper amounts of nutrients and antioxidants are also at a higher risk for clots.
Conditions or body positions that slow blood circulation—extended bed rest or sitting in a car or airplane for long periods of time—may also cause blood clots to form; although one recent British study suggests that the risk of so-called "traveler's thrombosis" is not as great as has been thought. Blood clots can be caused by increased fibrinogen (a blood-clotting factor) due to estrogen in the late stages of pregnancy and from long-term use of birth control pills. Other factors include varicose veins, childbirth, sickle cell anemia, smoking, obesity, liver disease, and cardiovascular disorders.
There may be no obvious symptoms of a blood clot. When symptoms do occur, they often appear suddenly, and point to the location of the clot. Extreme dizziness that occurs without warning can indicate a clot in a cerebral artery. Sudden complete or partial blindness in one eye could indicate a clot within the retinal artery. A hard blue bulge in a vein, or unexpected pain in an arm or leg, along with numbness, weakness, or another sign that blood is not reaching the area, could indicate a blood clot. Blisters or ulcers on the skin may occur as well. A clot in an artery near a major organ like the heart or lung will produce pain or decreased activity in that organ. Gangrene (death of tissue) may occur if blood flow to a region is blocked for an extended period of time.
Diagnosis
The patient will describe the severity and location of the pain he or she has been experiencing. A physician may also notice such physical signs of a blood clot as the swelling blue bulge, discoloration of a limb, or an ulcer. Medical personnel will also check for a missing or lowered pulse or blood pressure in a limb. A Doppler ultra-sound examination, angiography, or arteriography may be used to detect the location of the clot.
Treatment
Nutritional therapy may include the following: vitamins B3 (niacin), B6, C, and E; fatty acid and garlic supplements; and the minerals zinc, magnesium, and manganese. Herbal remedies may include cayenne (Capsicum frutescens), other hot peppers, and gingko (Ginkgo biloba) to help reduce the protein fibrin, which is a necessary factor in blood clots. Bilberry (Vaccinium myrtillus), turmeric (Curcuma longa), and ginger (Zingiber officinale) help reduce platelets' stickiness, which is essential for clot formation. Onion (Allium sepa) and garlic (A. sativum) help reduce fibrin and platelet stickiness. Patients who are taking prescribed anticoagulant drugs should consult their doctors before starting vitamin, nutritional, or herbal therapies.
Hydrotherapy treatment for blood clots can include contrast applications. The patient alternates using hot and cold treatments on the body in the area of the clot to increase blood flow. A naturopath will recommend specific remedies based on the symptoms and personality of a particular patient. A remedy for blood clots may include Hamamelis. Massage can be helpful if blood clots are a result of poor circulation, although care should be taken if a person suffers from phlebitis, since a clot could mobilize and lodge elsewhere.
Allopathic Treatment
Anticoagulant (anticlotting) drugs are usually prescribed for patients with blood clots. Streptokinase is a drug that will help dissolve clots that are already present in the body. Heparin inhibits platelet clumping, and can be prescribed after surgery, when blood is likely to clot. A new and promising treatment to prevent clot formation associated with septic shock is a recombinant form of activated human protein C, a natural anticoagulant. Doctors may prescribe aspirin for people who are at risk for having blood clots, although aspirin can injure the stomach lining. Patients may want to ask their doctors about what can be done to minimize damage from aspirin. Surgery is only recommended to remove blood clots that appear to be life-threatening or will cause tissue death if not removed.
Expected Results
If a clot goes undetected it is potentially dangerous, and could lead to a stroke, heart attack, or other serious complication. It is important to have any sudden unexplained pain or loss of function checked out by a doctor. If the blood flow to a limb is blocked for an extended period of time, gangrene may set in, and the limb may require amputation. Diet and exercise can help prevent future clots.
Prevention
Some risk factors, such as genetically related diseases, cannot be minimized. But minimizing other risk factors will help prevent problems with blood clots. Quitting smoking, controlling obesity, and improving nutrition can help reduce the risk of problematic blood clotting.
A healthy diet with high-fiber, low-cholesterol foods and plenty of fruits and vegetables can help prevent blood clots and many of the conditions that can lead to blood clots, such as atherosclerosis. In addition, such foods as garlic, ginger, onions, and hot peppers can help reduce platelet stickiness and formation of clots. Fish oils and supplements that add nutrients to the diet are recommended as well.
Moderate exercise helps keep off extra weight and improves circulation, both of which help reduce risk factors for formation of blood clots. Exercise can also reduce the risk of blood clots in women who use birth control pills for long periods of time. Those who must sit for long periods of time—on an airplane, in a car, or at work—can help prevent blood clots by wearing loose clothing, walking, and stretching their legs whenever possible. Flexing and releasing the lower body muscles, even while sitting, can help improve circulation as well.
Thrombus
Blood clot diagram.
A thrombus, or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system (i.e. clotting factors). A thrombus is physiologic in cases of injury, but pathologic in case of thrombosis.
Specifically, a thrombus is a blood clot in an intact blood vessel. A thrombus in a large blood vessel will decrease blood flow through that vessel. In a small blood vessel, blood flow may be completely cut-off resulting in death of tissue supplied by that vessel. If a thrombus dislodges and becomes free-floating, it is an embolus.
Some of the conditions which elevate risk of blood clots developing include atrial fibrillation (a form of cardiac arrhythmia), heart valve replacement, a recent heart attack, extended periods of inactivity (see deep venous thrombosis), and genetic or disease-related deficiencies in the blood's clotting abilities.
Preventing blood clots reduces the risk of stroke, heart attack and pulmonary embolism. Heparin and warfarin are often used to inhibit the formation and growth of existing blood clots, thereby allowing the body to shrink and dissolve the blood clots through normal methods (see anticoagulant).
A thrombus differs from a hematoma by:
- The thrombus is INTRAVASCULAR, the hematoma is EXTRAVASCULAR
- Having high hematocrit
- Being non-laminar
- Being soft and friable
- Having an absence of circulation
- Changes in vessel wall morphology (e.g. trauma, atheroma)
- Changes in blood flow through the vessel (e.g. valvulitis, aneurysm)
- Changes in blood composition (e.g. leukaemia, hypercoagulability disorders)
Disseminated intravascular coagulation (DIC) involves widespread microthrombi formation throughout the majority of the blood vessels. This is due to excessive consumption of coagulation factors and fibrinolysis using all of the body's available platelets and clotting factors. The end result is ischaemic necrosis of the affected tissue/organs and spontaneous bleeding due to the lack of clotting factors. Causes are septicaemia, acute leukaemia, shock, snake bites or severe trauma. Treatment involves the use of fresh, frozen plasma to restore the level of clotting factors in the blood.
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