by Dr. Shay Fabbro
Most people don’t give much thought to the formation of blood clots. They are an essential part of life since without them we would bleed to death if we got a cut. But there are times when clots can be dangerous, especially when they form when there isn’t a reason to. They can block arteries and cause all sorts of havoc for people with congestive heart failure (CHF), like Brian has.
The Clotting Process
The process of forming a blood clot starts when a blood vessel is broken, by either a small papercut or deep gash. Special cells found in the blood, called platelets, can detect the breaks in the blood vessels. They change shape, from round to spiky, and stick to the broken vessel. These little cells secrete a bunch of different proteins that all play a role in recruiting more platelets to the wounded vessel, where they pile on top of one another, forming a plug. Another special protein called fibrin lays across the plug, much like we lay a gauze pad across a large wound. This fibrin meshwork helps to seal the wound so that healing can begin.
Breaking Down Blood Clots
Once the blood vessel is healed, the blood clot needs to be broken down. A set of proteins called the plasminogen activator (PA) system take care of breaking down the clot so that blood once again flows freely in the vessel. I’m sure all of us have had a nasty cut…or ten (what can I say, I’m a clutz!!!). The scab doesn’t just disappear into thin air; the disappearing scab is being broken down by the PA system!
Atherosclerosis
Atherosclerosis is a fancy word for hardening of the arteries. It’s caused by collections of fat, cholesterol, and other stuff that builds up on the walls of the blood vessels, occluding them. These deposits will continue to grow until they completely block the blood vessel. Blood carries oxygen to every cell in our bodies. If blood doesn’t flow, then our cells can’t get enough oxygen, which will cause them to die. When Brian’s heart was damaged by the occlusion, this meant that his heart had to work even harder since some of the cells were dead. The harder his heart worked, the weaker it became, so that it couldn’t pump the blood his body needed. This causes him to have a low ejection fraction (EF), which is a measurement of how much blood is pumped to the body.
Controlling Blood Clots
There are many instances where someone needs a little help to control the formation of blood clots: recent surgery, broken bones, cancer, confined to bed, family history of blood clots, sitting for too long, and in Brian’s case, CHF. Unwanted blood clots can cause heart attacks and strokes, which are the leading cause of death in the US.
Drugs to Control Blood Clots
There are a number of drugs a physician may prescribe to help control the formation of blood clots:
1) Aspirin-this one is a big one, and easy to get your hands on. A low-dose aspirin tablet taken every day can thin the blood so that clots don’t form. It is important to note that when on a daily aspirin regimen, the patient can’t simply stop taking the aspirin as this can cause clots to form. The decision to stop taking the drug should always be discussed with your doctor.
2) Heparin-this strong anticoagulant is something that is given through an IV, so it usually must be given in the hospital. The nature of this drug also means that the patient must be carefully monitored. This means a lengthy stay in the hospital, which can impact jobs and cause financial stress.
3) Warfarin (Coumadin)-this anti-clotting drug is given in pill form, making it easier to give to patients. Other drugs can interact with Coumadin (aspirin, Tylenol, ibuprofen, certain vitamins and antibiotics) so it’s important for patients to tell their doctor all medications they are taking. Brian is on this drug, which helps to control the clotting in his legs.
4) Plavix-Brian is also taking this drug, which is an anti-platelet drug to help prevent strokes and heart attacks. Many of you may have seen advertisements for this on the TV J
Drugs to Control Plaque Deposits
Since Brian had occlusions in his blood vessels, he must also be a drug to control the build-up of fats and cholesterol:
1) Lipitor-This is also a drug that Brian is currently taking. It decreases the amount of cholesterol in the blood. And it’s another one you may have seen on TV.
Death: living to talk about it 