top doctors mexico Deep Vein Thrombosis: Provoked and Unprovoked Blood Clots Treatment (5)

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Professor Dr. Aric Parnes MD, hematologist-oncologist, expert in anemia, blood clots, myelodysplastic syndrome, MDS, leukemia and lymphoma treatment, and Dr. Anton Titov MD / Exclusive interview

- We started the conversation with disorders of abnormal bleeding, when blood does not have enough ability to form clots. But blood clots sometimes form where they should not form - a thrombosis. Blood clot causes and treatment is one of your clinical and research interests. Thrombosis is a large problem. When clots break from the leg veins, they travel to lungs and cause pulmonary embolism. It has a 30% death rate. When blood clots form in a coronary artery, this causes myocardial infarction. These are all very serious problems. Please talk about causes of thrombosis. How to diagnose blood clots properly? What are the best treatment methods for thrombosis? We divide thrombosis into venous thrombosis or arterial thrombosis. Hematologist deals primarily with venous thrombosis. The arterial thrombosis is the realm of cardiologists when it causes myocardial infarction, heart attack, Thrombosis in the brain causes strokes. This is in the realm of neurologists. There is an overlap with cardiology and neurology, but hematologist works with venous thrombosis. for example, clots in the legs [deep venous thrombosis]. Blood clots can break off from leg veins and travel up to the lungs. This causes pulmonary embolism. Cancer can also cause blood clots, a so-called "hypercoagulable state", when blood has increased propensity to form clots. Deep venous thrombosis could be the first sign of cancer. That is correct. Blood clots in veins can often be a first sign of cancer in the body. This brings us to "hypercoagulable state" [increased risk of blood clotting]. Who are the patients that get thrombosis? Cancer patients are certainly at risk of venous thrombosis, People who cannot move well and who are in a hospital, patients with bone fractures are all also at risk of thrombosis because they cannot be as active as they had been. Elderly and obese people are at risk of venous thrombosis for similar reasons. Pregnancy also leads to increased risk of vein thrombosis. Recently we discovered genetic predispositions to venous thrombosis. Factor V Leiden thrombophilia is a gene polymorphism that is common in people of Northern European ancestry. Factor V Leiden increases risk of deep venous thrombosis and pulmonary embolism. There is also the prothrombin gene mutationthat can predispose people to blood clots in legs and to pulmonary embolism. There are other mutations in clotting cascade that increase risk of venous thromboembolism, If Protein C or Protein S, or antithrombin III are missing, it also causes increased risk of abnormal clotting of blood. Most of the time we don't know what causes blood clots to form. So we call these unexplained blood clots "unprovoked clots" or idiopathic clots. In contrast, provoked blood clots happen after operation or a period of immobility. Cancer treatment can cause blood clots. Birth control pills increase risk of clots. Estrogen increases thrombosis risks. Estrogen is a female sex hormone contained in birth control pills. That's right. One of the most important risks of birth control pills is blood clots. So anybody with known hypercoagulable state should not get any kind of estrogen supplementation. But birth control pills are a very common medication. If a woman takes birth control pills and then develops a blood clot, then we can recognize that risk and stop that medication. Is smoking an additional risk factor for venous thrombosis for women on oral contraceptives? Yes, it is. We can think about risk for blood clot formation as a concept of threshold. A person can accumulate different risk factors for increased blood clotting: smoking, oral contraception, obesity. Eventually risk factors add up and blood clot is formed. When we see several risk factors for thrombosis, we try to minimize them. For example, a woman might have a known Protein C deficiency diagnosed because her mother had a blood clot and daughter had genetic tests done. I'd make sure that patient is never given oral contraceptive pills. Is there a test for Protein C deficiency? - Yes, there is. We typically don't test for these risks of thrombosis unless there is a family history of blood clots, or multiple clots already happened. Treatment of deep vein thrombosis and other hypercoagulable states is very similar. We prescribe blood thinners, there are many options, including a new recent class [NOACs]. Warfarinand heparin are classic anticoagulant medications.

top doctors mexico Deep Vein Thrombosis: Provoked and Unprovoked Blood Clots Treatment (5)
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