Thrombosis is caused by the formation of a clot in a vein or artery , which obstructs the passage of blood and consequently the oxygen needed by the cells. It is not a disease in itself, but a cause that determines a series of diseases that take their name from the affected organ and are classified as cardio and cerebrovascular.
Thus, venous thrombosis and arterial thrombosis are distinguished . A third group consists of systemic thrombosis . Venous thrombosis can be superficial or deep. One of the most serious consequences of venous thrombosis is pulmonary embolism . Arterial thrombosis, depending on the organ it affects, also causes specific pathologies. We speak of venous or arterial cerebral, abdominal, retinal thrombosis. One of the most serious consequences of arterial thrombosis is stroke .
However, thrombosis is caused by a series of risk factors, both of a genetic nature and deriving from particular external conditions or causes.
However, if suspected and diagnosed in time and if the doctor intervenes promptly with the drugs that medicine makes available today, thrombosis can be effectively treated. But, above all, permanent damage to the organs concerned or, in the most serious cases, death can be avoided.
The October 13 is World Day of thrombosis: world trombosis day .
The thrombosis diseases are severe and more frequent than imagined and are the leading cause of death in Italy and in the world . Furthermore, they are collectively defined as cardio and cerebrovascular diseases.
- myocardial infarction
- brain stroke
- pulmonary embolism
- venous and arterial thrombosis.
Unfortunately, they are the great epidemic of our day and they affect twice as many cancers: every year 4 million people in Europe die from cardiovascular and cerebrovascular diseases.
In addition, they affect men and women, old and young, and even children.
In particular, venous thromboembolism affects 1 in 100 people every year in Italy and is the most likely cause of complications and death in women after childbirth.
Thrombosis: what is it
Thrombosis is the mechanism that partially or completely closes a vessel, artery or vein.
Hence, it is the consequence of an increased tendency of the blood to clot . This phenomenon can occur in all the arteries and veins of our body , reducing the arrival of oxygen and essential nutrients to all organs.
It can occur in the retina, brain, liver, intestines, but also in the arms, legs and placenta in pregnant women.
It is the cause that determines a series of diseases, which are named after the affected organ.
It was only in the 1980s that thrombosis began to be talked about as a cause of myocardial infarction, cerebral stroke, pulmonary embolism, identifying it as a common trigger for different diseases affecting different organs.
In fact, myocardial infarction was found to be caused by a thrombus formed in a coronary artery. On the other hand, stroke is caused in most cases by a piece of thrombus from the heart or carotid artery that has become an embolus that causes stroke in the brain.
The severity of the consequence of thrombosis depends on how important the affected organ is, how extensive the thrombus is, how quickly it forms and dissolves .
Also read Phlebitis symptoms prevention-and-cure
Anatomy – what is a thrombus
A thrombus is a blood clot that partially or completely closes an artery or vein, and reduces or completely prevents the arrival of oxygen and nutrition to the cells. So, the consequence is that the organ that received nourishment from that vessel goes into suffering.
Thus, a thrombus forms because the blood becomes gelatinous . A change that we can easily observe when we have a wound, the blood from liquid becomes gelatinous and then forms a scab. It is the mechanism that stops bleeding , heals inflammation and helps build the scar.
The same occurs not only on injured skin, but also inside arteries and veins to stop bleeding, heal inflammation or infection, help rebuild damaged tissue.
However, inside the vessels, the clot (thrombus) must form quickly and dissolve just as quickly, otherwise it closes the vessel and causes ischemia .
The thrombus: characteristics
The blood coagulates only when it should and not “out of the blue”: there is a complex and delicate mechanism that regulates the balance between the tendency of the blood to clot and the need for it to remain fluid. But, when this balance is fragile, for genetic or transitory reasons, thrombi can form.
In addition, a thrombus can also form inside the heart . For example, when the valves inside it are diseased or replaced with mechanical or biological implants and the patient is not sufficiently protected by anticoagulant drugs. Or when the heart fibrils, that is, the heart moves in a disordered way and is unable to empty itself as it should, the blood slows down its course and coagulates .
It can occur in dilated hearts, patients with dilated heart disease or heart failure.
How a thrombus forms
The veins and arteries are like elastic tubes lined inside by endothelium, which can be compared to a “tiling” with tiles adhering to each other.
But, when a wound, inflammation or virus interrupts this tiling , the platelets immediately intervene. Platelets are cells that aggregate , accumulating on each other to block bleeding , that is, the escape of blood from the interruption of the vessel wall, and inflammation.
When platelets aggregate, they change shape, swell and release substances in the blood that recall clotting factors to build the cement that must repair the injured vessel and stabilize the clot .
Thus, this sophisticated and fascinating system regulates itself, because the anticoagulant factors intervene to regulate the procoagulants and block the clotting process when it has done its job.
Where it forms
The thrombus that forms in an artery and prevents the arrival of blood and oxygen to the cells, which die without nourishment, is called a heart attack.
Instead, the thrombus that forms in a vein slows down or prevents blood from returning to the heart. Then, the liquid part of the blood exits the vessel and impregnates the surrounding tissues, causing edema and swelling , and the cells suffocate from compression or lack of oxygen.
The arterial thrombosis is more serious than that vein , because the lack of oxygen kills quickly by suffocation cells and causes immediate suffering body concerned.
However, venous thrombosis is also very dangerous, because it can release fragments called emboli , which reach the heart and from the heart are pushed into the lung, causing pulmonary embolism , asphyxiation and death of part of the lung.
Thrombus: damage and severity
The damage that a thrombus causes depends on a few conditions:
- type of vessel in which it forms (whether it is an artery or a vein)
- vessel size (large, small or microscopic)
- importance of cells that remain without oxygen.
Hence, thrombus causes serious consequences when it is large, or small but forms in a fundamental, albeit small, artery, such as the retinal artery, and does not dissolve quickly after it has accomplished its mission.
The severity also depends on the type of thrombosis, that is , if it is complete or partial , and on the speed with which the thrombus dissolves. Finally, also from the fact that it fragments leaving emboli that cause ischemia and embolism in an organ far from the vessel in which the thrombus was formed.
Why a thrombus forms: causes
In conclusion, at least three conditions must be present for a thrombus to form:
- slowing blood circulation
- procoagulant factors in excess of natural anticoagulant factors
- alteration of the wall of the vessel, artery or vein, which causes the circulating blood to come into contact with substances with which it normally does not come into contact, so it ignites and coagulates.
Types of thrombosis: classification
There are three main classes of thrombosis: venous, arterial and systemic .
Instead, the various types of thrombosis are classified according to the formation of the thrombus , its size and the part of the body it affects.
Thus, the consequences of thrombosis take different names depending on which organ the thrombosis affects and whether they form in a vein or an artery.
1 – Venous thrombosis
A venous thrombosis occurs when the thrombus has occurred within a vein. The effect of the thrombus is similar to a narrowing or filling that forms in the blood vessel and impedes the flow of blood. In the case of a vein, this is the flow of blood returning to the heart.
In veins, blood circulates with less pressure than it circulates in arteries. However, the walls of the veins are not as elastic and strong as those of the arteries. The blood in the veins must return from the periphery to the heart, attracted by the suction movement of the heart. But, if the blood finds obstacles compressing the vein, it slows down its course. Then, the coagulation system activates and forms a thrombus, which partially or completely closes the vein, preventing the blood behind the thrombus from returning to the heart.
Thus, the liquid part of the blood exits the wall of the veins, which are permeable, soaks the surrounding tissues and generates the symptoms of venous thrombosis, in particular swelling and pain.
Venous thrombosis can be deep or superficial . The superficial form is called thrombophlebitis. In both cases, the parts of the body where it occurs most are the legs and arms.
Deep vein thrombosis
It frequently forms in the veins of a leg or arm.
More often it forms in the veins of the legs , in less than 3 out of 100 cases it forms in the veins of the arms.
However, the fact that thrombosis affects an arm or a leg, and not a vital organ, should not lead to underestimating it. In fact, parts of the thrombus, called emboli , can break off and be carried by the bloodstream to the heart and from there to the lungs, causing a pulmonary embolism .
The prevention and therapy of deep vein thrombosis are based on the use of anticoagulant drugs.
Thrombophlebitis (or superficial vein thrombosis)
It is the thrombosis of a superficial vein accompanied by a marked inflammation . It often occurs in the legs, but also in the arms or more rarely on the abdomen, chest, penis.
Then, the affected vein becomes hard, red and sore. It should not be underestimated , it should be reported to the doctor and the diagnosis should be confirmed with a Doppler ultrasound.
It must be treated with anticoagulant drugs, as is the case with deep vein thrombosis.
Here, we are dealing with the set of consequences caused by a poorly treated or unrecognized or repeated venous thrombosis over time. It mostly occurs in the legs.
In fact, the veins appear tortuous and dilated , becoming varicose or varicose veins, in which the blood tends to stagnate. In addition, reddish or dark spots appear on the skin of the leg , sometimes even quite extensive ulcers that heal with difficulty and can become infected.
In addition to a cosmetic problem, this condition causes continuous pain , feeling of tired and swollen legs, especially after a long time standing.
This is the most serious and feared complication of venous thrombosis, especially deep but also superficial.
The embolus is a fragment of thrombus that detaches from where it formed and travels through the blood, stopping only when it encounters a vessel small enough to be blocked. Then, as veins carry blood from the periphery to the heart, the embolus that detaches from the thrombus formed in a vein goes to the heart and from there to the lung, causing pulmonary embolism.
Unfortunately, it represents the third cause of death in the world and in Italy it affects one in 100,000 people every year.
2 – Arterial thrombosis
Thrombi that form in the arteries have a high component of platelets, which is why they are treated with antiplatelet drugs , which must keep platelets from excessive tendency to aggregate. It usually occurs in arteries affected by atherosclerosis or affected by inflammatory diseases such as vasculitis, or by viruses, or by autoimmune diseases.
In fact, these diseases have in common a powerful inflammatory state, caused by different factors. For example, in the case of atherosclerosis, cholesterol levels that are too high for too long over time, in conjunction with diabetes, poorly controlled hypertension, cigarette smoking, drugs, contribute to inflame the walls of the arteries and cause the reaction of the coagulation system , which intervenes to extinguish the fire of inflammation and forms thrombi with the aim of extinguishing the fire.
So, if the thrombi are too large or do not dissolve quickly after doing their job, they take up space, close the vessel, and the tissues that received nourishment from that vessel, suffer and die. If emboli are released from the thrombus, arteries distant from the point where the thrombus had formed are closed with symptoms determined by the suffering of the organ where the emboli arrived.
Furthermore, the sudden closure of an artery caused by acute stress, a fright, a great pain can trigger a heart attack with or without thrombosis.
Finally, arterial thrombosis is also named after the affected organ .
3 – Cerebral thrombosis
In this setting, thrombosis of the cerebral veins and thrombosis of the cerebral arteries can occur.
Thrombosis of the cerebral arteries
Closure of a cerebral artery causes a stroke.
In fact, thrombosis often occurs on atherosclerotic plaques, on the arterial wall inflamed by:
- too high cholesterol and for too long;
- hypertension recognized late or not recognized and not treated;
- dangerous habits such as cigarette smoking or drug abuse.
Sometimes a stroke can also be the result of the arrival of an embolus that closes a cerebral artery, starting from the heart or the carotid arteries. Hence, the embolus travels in the blood and obstructs one or more branches of the arteries that carry oxygen and nutrition to the brain, a noble organ that governs fundamental functions such as:
Thrombosis of the cerebral veins
The closure of one or more veins of the brain by a thrombus causes subtle and not always immediately recognizable symptoms.
Unfortunately, it is common in women on hormone therapy, during pregnancy, in the period after delivery.
Venous and arterial retinal thrombosis
It can occur in an artery or vein . It is often the consequence of a thrombus formed directly in the retinal circulation or of an embolus originating from an atherosclerotic plaque on the carotid or from a thrombus formed in the heart that fibrils, often without the patient noticing.
However, it can cause transient or permanent blindness with serious damage to the patient’s quality of life.
The arteries that feed the retina (the final part of the optic nerve, the organ that allows you to see) are very small.
Therefore, thrombosis of one or more branches of the retinal arterial circulation dramatically reduces the arrival of blood and therefore of oxygen to the nerve cells that make up the retina. These cells suffer, and if the thrombosis is rapid and complete, they die, and the patient loses the ability to see.
4 – Abdominal thrombosis
Abdominal thrombosis can also be venous or arterial .
These are frequent events in patients suffering from important diseases such as:
- febrile viral diseases that cause an enlarged spleen
They may be, but not necessarily, the first symptom of yet undiagnosed hidden tumors. Finally, they can accompany acute or chronic inflammation of the intestine such as colitis or intestinal diverticulitis.
Abdominal thrombosis can occur in the veins or arteries of the following organs:
Abdominal venous thrombosis
In particular, the portal venous circulation (liver) can be affected by thrombosis , even without the patient having symptoms, but thrombosis usually occurs in the presence of an inflammatory disease of the gastrointestinal system or the liver itself.
Preliminary diagnosis can be made with an accurate ultrasound scan in expert hands.
Treatment consists of the use of antithrombotic drugs, especially anticoagulants. But we must always look for, to confirm or exclude them, any diseases of the abdominal organs that may have favored the thrombosis, and must be treated so that they do not contribute to worsening the picture.
Abdominal arterial thrombosis
Thrombosis of an abdominal artery is often serious, because it causes a heart attack in the affected organ: if it hits an intestinal artery it causes an intestinal infarction , that is, the necrosis of a part of the intestine and the omentum, the fan-shaped membrane that holds the ‘intestine.
In addition, this is manifested by acute pain, fever and diarrhea , and is often accompanied by peritonitis complicated by intestinal perforation , which requires urgent surgery to avoid septicemia and death.
So, if it affects another of the abdominal organs it will give symptoms related to the function of that organ (liver, spleen, kidney, ovaries).
5 – Systemic thrombosis
This term refers to a very serious phenomenon, which doctors define as a catastrophic syndrome . Technically, it is called “ disseminated intravascular coagulation syndrome ”, in which several and numerous thrombi form simultaneously in different parts of the body, in veins or large and small arteries.
In fact, it occurs as a serious complication of acute inflammatory diseases with a high fever or widespread tumor diseases.
For example, in the case of viral infections such as COVID-19 , the lungs infected with the virus become inflamed, the gas exchanges normally regulated by breathing are reduced because the lung is occupied by the fluids produced by the inflammation, which causes a severe, widespread and very rapid production of inflammation molecules, which inflame the entire circulatory system.
At this point, the blood clotting system is activated by the inflammatory state and increases the tendency to clot, producing diffuse thrombi , which consume clotting factors and platelets, paradoxically causing diffuse thrombosis and hemorrhages in all organs of the body, which lose the their function. Then, the patient dies from pulmonary embolism, heart failure, renal and hepatic failure.
Fortunately, this is a very rare event , which doctors know and fear, which is why it is called a catastrophic syndrome and is often fatal.
Finally, it is always to be feared in case of:
- extensive trauma with damage to many organs
- very extensive burns
- septicemia for a bacterial infection.
It manifests itself with some symptoms that depend on the affected district:
- leg or arm swell suddenly
- very severe pain similar to a cramp that does not go away
- the skin overlying the affected vein becomes red and hot
- other veins in the arm or leg become dilated and more noticeable than normal, or tortuous.
However, thrombosis can be suspected, confirmed or ruled out with a venous Doppler ultrasound and with a blood test that measures D-dimer, which is equivalent to the ash that forms during a fire. In fact, under normal conditions, D-dimer should not be present in the blood, it only appears when a blood vessel repair system is in progress.
Therefore, in case of suspicion , contact your doctor without wasting time , who will prescribe the necessary tests to confirm the suspicion, specify the diagnosis and prescribe the appropriate treatment.
Thrombosis of the cerebral veins
It often manifests itself with an acute and intense headache , which does not regress with common analgesics, accompanied by the feeling of having the head too full, up to loss of consciousness.
It is a serious event, but it can be cured if diagnosed in time.
Pulmonary embolism is often silent , that is , it does not give any symptoms.
Thus, it can cause some symptoms but these are non-specific and not unique to pulmonary embolism, so they can be confused as signs of another disease. Symptoms can be:
- pain in the chest or back
- sudden shortness of breath
- rapid or irregular heartbeat
- cough with traces of blood in saliva or phlegm.
Arterial retinal thrombosis
It is manifested by the sudden total or partial loss of the ability to see in one eye , very rarely in both eyes at the same time.
Furthermore, it is sometimes preceded by episodes of transient partial blindness that resolve spontaneously in a few minutes, but are a wake-up call that anticipates a more important and more definitive event, not only in the retina but also in the arteries of the brain.
Venous retinal thrombosis
It is a much more frequent occurrence than you think. In fact, the thrombus is formed in a vein of the retinal system closing a part of it permanently or transiently.
In addition, people who are over 50, suffer from cardio or cerebrovascular disease, or have an excessive tendency for blood to clot, called thrombophilia ,are more at risk .
Thrombosis of a retinal venous branch can cause a sudden decrease in the ability to see part of the visual field. Basically, it is as if looking at a painting you only see a part of it.
But the loss of vision depends on the size of the vessel occupied by the thrombus. It usually does not cause pain.
Abdominal arterial thrombosis
Thrombosis of an abdominal artery is often serious, because it causes a heart attack in the affected organ : if it hits an intestinal artery it causes an intestinal infarction, that is, the necrosis of a part of the intestine and the omentum, the fan-shaped membrane that holds the ‘intestine.
In addition, this is manifested by acute pain, fever and diarrhea , and is often accompanied by peritonitis complicated by intestinal perforation, which requires urgent surgery to avoid septicemia and death.
So, if it affects another of the abdominal organs it will give symptoms related to the function of that organ (liver, spleen, kidney, ovaries).
In some cases there is diarrhea, vomiting, paralysis of the intestine with intestinal obstruction.
Finally, sometimes the diagnosis of thrombosis is neglected and mistaken for appendicitis or peritonitis, particularly in the case of intestinal venous thrombosis.
The causes of thrombosis
The complex system that allows the blood to flow fluid under normal conditions and to change its physical state, coagulating when needed, is called hemostasis.
Thus, the balance of this system depends in part on the characteristics inherited from our parents and in part on transient factors that can accentuate the natural tendency of the blood to clot in particular conditions. To name a few, transient factors can be:
- period immediately following childbirth
- sepsis or septicemia
- surgical interventions
- hormone therapies
- kidney failure
- heart disease
In fact, thrombosis diseases are team diseases: a predisposing genetic structure is not enough, more accomplices are needed to cause them. Therefore, the more risk factors are present at the same time , the more likely thrombosis and its more serious consequence, embolism will be.
Transient and genetic risk factors
The subjects most at risk of thrombosis are those:
- overweight and with a bulbous abdomen
- pregnant women
- suffer from inflammatory or joint or autoimmune diseases
- who have a tumor
- with lower limb fractures and trauma
- with previous thrombosis
- bedridden for febrile illness
- who have had a trauma, a cast, a recent surgery
- women undergoing hormone therapy
- suffer from heart failure or kidney disease.
Furthermore, the mutation of some clotting factors can make the balance between procoagulant factors (which cause the blood to clot) and anticoagulants (which keep it from clotting too much) fragile. The most frequent mutations are those of:
- Leiden of factor V
- G20210A of prothrombin.
These mutations are present in five out of 100 people in the healthy population.
However, those who have these mutations will not necessarily face a thrombosis sooner or later, but must consider them a sign of the fragility of a system which, if caused by several risk factors present at the same time, is less resistant to the temptation to coagulate.
Other transient factors
- high levels of homocysteine in the blood can inflame the walls of the veins (and arteries) and increase the likelihood of thrombosis
- increased abdominal fat
- thyroid disease
- recurrent infections, especially cystitis
- acute and chronic inflammatory diseases
- febrile illnesses that force you to bed for a long time
- some tumors that release procoagulants or compress the veins
- immobilization for trauma, surgery, plaster cast
- hormonal therapies and hormonal imbalances
- pregnancy and childbirth
- chemotherapy and the presence of venous catheters.
Thrombosis: predisposition, genetics and age
Thrombosis is not hereditary but the tendency of the blood to clot too much in particular situations can be hereditary.
In fact, those who carry one of the known mutations (a condition which is called thrombophilia ) will not necessarily have a thrombosis during life. However, he must take this fragility into account and protect himself when exposed to a risk situation or avoid overlapping multiple risk factors at the same time, correcting or eliminating the modifiable ones.
The risk of thrombosis increases with age, but thrombosis also affects young people and even children.
In fact, out of 100 people affected by venous thrombosis, 3 are under the age of 40.
In particular, in young athletes subjected to intensive training , especially for arms and shoulders, a venous thrombosis of the arm can occur due to compression of the veins by the rapid increase in muscle mass.
Thrombosis in pregnancy
In pregnant women, the probability of venous thrombosis quadruples from the beginning of gestation and progressively increases until it multiplies up to 25/60 times in the 60 days after delivery.
This phenomenon depends on several factors:
- hormonal structure of the pregnant woman which makes the veins more flaccid and less elastic
- compression of the uterus on the two iliac veins that must return blood to the heart
- change in blood balance between natural pro and anticoagulant factors
- slowed circulation in the placenta
- increased circulating blood.
Childbirth represents the moment of greatest risk for the increase in intra-abdominal pressure and for the compression of the baby on the pelvis in the phase of labor and expulsion.
Abortion must also be considered a risk factor for venous thrombosis.
Therefore, in both cases, the risk increases if the woman:
- she is confined to bed for a long time, for example due to the threat of abortion
- gaining excess weight or were already overweight before pregnancy
- has diabetes, hypertension and smokes
- uses support hormones to promote a successful pregnancy
- suffer from recurrent infections (cystitis / vaginitis)
- has one or more thrombophilic mutations
- suffer from heart disease
- have had previous episodes of phlebitis or thrombosis
- suffer from varicose veins
- have one or more family members who have had thrombosis or embolism at the age of 65.
Thrombosis and Viruses: Dangerous Relationship
All inflammatory diseases increase the risk of thrombotic, venous and arterial diseases. Viral diseases with high fever and requiring bed rest are no exception. Equally, seasonal influences, pneumonia, viral infections of various types are no exception.
The infection causes an inflammatory state that calls into action white blood cells, inflammatory molecules and platelets, which interact with clotting factors and with the endothelium that lines the inner walls of veins and arteries.
Thus, this disorder can facilitate blood clots in arteries and veins and increase the likelihood of:
- heart attack
- brain stroke
- venous and arterial thrombosis
- pulmonary embolism.
Coronavirus and thrombosis
“All viruses, and this is no exception, trigger a more or less violent inflammatory reaction in the affected organ, which spreads throughout the organism.
Doctors note every day that patients hospitalized for COVID-19 are affected by pneumonia with respiratory failure caused by the virus, often accompanied by cardiovascular complications and in particular by venous thrombosis and pulmonary embolism, ”said Dr. Lidia Rota Vender.
In fact, numerous studies are being published on this topic. Specifically, the first was a study of 183 patients with COVID-19 hospitalized in Wuhan, China, which showed:
- major changes in the coagulation system (haemostasis) with an increase in procoagulant factors
- increase in the number of platelets and their activation
- inflammation of the endothelium lining the inside of arteries, veins and capillaries.
Complications and consequences of thrombosis
If thrombosis occurs in an organ where every cell is vital, such as the heart and brain, the consequences are very serious.
On the other hand, if the phenomenon is contained or affects non-vital organs, it causes apparently less serious diseases such as venous thrombosis, but which can create very serious complications such as pulmonary embolism.
It is the consequence of the lack of blood and oxygen in an area of the brain, caused by the rupture of an artery (hemorrhagic stroke) or its occlusion by a thrombus / embolus (ischemic stroke).
Then, within minutes, the neurons suffering from lack of oxygen die and the parts of the body that those neurons controlled stop working.
Although stroke can be recognized and treated, it often leaves very severe disabilities.
In fact, hemorrhagic stroke is often caused by brain aneurysms that rupture and / or hypertension that is not recognized or poorly controlled with drugs, atherosclerosis and diabetes that make arteries more fragile.
Instead, ischemic stroke is often caused by a fragment of thrombus formed elsewhere. In particular, in a heart with diseased valves, dilated or fibrillating, or in diseased carotid arteries with atherosclerosis. Therefore, thrombi form in the heart and on the atherosclerotic plaques, which release emboli, which reach the brain by closing all or part of an arterial branch and preventing the arrival of oxygen to neurons, which suffer and die and cannot be replaced.
Thus, recognizing and treating diseases that increase the likelihood of stroke means reducing the likelihood of being affected and severely disabled or losing life.
It is the consequence of a thrombosis that completely or partially closes a branch of the coronary arteries, interrupting or reducing the blood supply to the heart muscle and causing the death of a greater or lesser quantity of muscle cells of the heart.
The severity of the heart attack and its consequences depends on the size of the affected area and the depth of the lesion.
Generally, the consequences are less severe if the heart attack affects only a limited part of the heart and if it is suspected and treated promptly.
Conversely, if the injury is very extensive, heart muscle function is impaired and can lead to death.
Peripheral arterial embolism and complications
When a fibrillated heart cannot completely empty itself of blood with each contraction.
Therefore, the blood that stagnates in the heart forms thrombi, which can occupy a part of the heart chamber or fragment, releasing emboli, which reach arteries far from the heart such as:
- brain, causing an ischemic stroke.
- arteries of the legs causing peripheral embolism
- abdominal arteries causing intestinal, splenic, renal infarction.
- Atherosclerosis is the most dangerous accomplice of thrombosis and peripheral embolism.
Gangrene is the most serious consequence of peripheral arterial embolism, which often occurs in patients with diabetes and atherosclerosis.
In fact, the cells die from lack of oxygen, and serious infections overlap the lesion and can lead to the amputation of the limb, leading to death from septicemia.
In addition, the legs quickly turn very pale because they suddenly don’t get any more blood or oxygen and the cells die. Hence, microbes settle on dead tissues leading to infection and septicemia. In irreversible cases, it is necessary to resort to amputation.
Thrombotic diseases can be treated, but they must first be suspected and diagnosed quickly.
In fact, the affected organ must be treated by the specialist (cardiologist, neurologist, angiologist). But, the coagulation system must be studied and balanced by a physician who is particularly competent in coagulation. In fact, any imbalances must be corrected to prevent future new thrombotic diseases in the same organ or in another.
Generally, to treat thrombosis, anticoagulant drugs are used , which reduce the ability of the blood to clot and therefore make it more fluid just enough so that no new thrombus forms and those already formed dissolve. At the same time, it doesn’t have to be too fluid so that no bleeding occurs.
But, in severe cases, when venous thrombosis becomes complicated with an embolism, thrombolytic drugs are administered in the hospital, which must dissolve the blood clots quickly.
Therefore, the choice of the antithrombotic drug suitable for each individual situation and for each individual patient must be made taking into consideration:
- organ affected
- type of thrombosis
- specific characteristics of each individual patient.
In addition, the patient must cooperate with the doctor by taking the medications with care and discipline, to get the maximum benefit from the treatment and avoid unpleasant consequences, such as bleeding or a new thrombosis.
They are drugs that slow down the action of procoagulant factors present in the blood, they are always used in venous thrombosis and pulmonary embolism, but can also be effective in arterial thrombosis.
In fact, at adequate doses they are used not only to treat thrombosis and embolism in progress but also to prevent new events. in those who have already had a thrombosis.
In addition, there are different types of anticoagulant drugs, which act with slightly different mechanisms, some can be administered by mouth, others must be administered by subcutaneous or intravenous injection.
They are a well known family of oral anticoagulant medications that have been in use for over 80 years.
They work by partially blocking the action of vitamin K , essential for the liver to produce natural procoagulant molecules. In this way, they reduce the arrival of vitamin K to the liver, which then produces less procoagulants and the blood remains more fluid.
Patients taking dicumarols should be monitored with periodic samples that measure the PTINR, a test that indicates how thin the patient’s blood really is. In addition, specific oral anticoagulant therapy surveillance centers have the expertise and organization to best treat and monitor these patients, who are often frail and elderly.
Then, based on the result of the PTINR, the doctor adjusts the doses of anticoagulant for the individual patient.
Thus, constant surveillance allows patients who are often frail or elderly or with different pathologies to be followed appropriately, minimizing the likelihood of the most serious consequence of excessive anticoagulation: hemorrhage.
Furthermore, today there are new oral anticoagulant drugs that do not require periodic checks with blood samples and that can be prescribed in selected patients and at the expense of the national health service.
In this case, they are used in fixed doses. However, as they do not have a test that measures how much blood is actually thinned by the drug, unfortunately they cannot be used in very elderly or frail patients, with kidney or liver failure or with previous bleeding.
They are drugs that block the activity of platelets, preventing them from clumping together, making the blood more fluid and preventing blood clots from forming in the arteries.
Therefore, they are useful in preventing the progression of atherosclerosis, a new heart attack in those who have already had one, or a first heart attack in those with multiple risk factors such as age, hypertension, high cholesterol levels, diabetes.
However, anticoagulants and antiplatelet agents are usually not used simultaneously in the patient because blocking both platelets and clotting factors increases the risk of bleeding. Instead, they are used only in selected patients who are unresponsive to the individual drug and will need to be closely monitored.
Venous thrombosis: how to treat it
Both prevention and therapy involve the administration of drugs to reduce the tendency of the blood to clot in a disorderly way, and make it more fluid so that it does not clot too much, but not too fluid so that bleeding does not occur.
These drugs are:
- heparins, which are injected under the skin, and in particular cases intravenously
- oral anticoagulant drugs .
Furthermore, the treatment must be adapted to the patient’s characteristics and prolonged until the thrombus has completely dissolved and the affected vessels have completely cleared the thrombus attached to the walls. In fact, it can last anywhere from three months to a year or more .
On the other hand, in the most serious cases, in which the thrombus has released emboli that reach the lung, the heart fights to push the blood into a small aqueduct because it is partly occupied by emboli. Then it expands, losing efficiency. In these cases, doctors use very powerful drugs, called thrombolytics, which must be used only and exclusively in a hospital environment and under careful control.
In fact, they are drugs that must rapidly dissolve the thrombus / embolus to free the hydraulic system of the affected organ and restore its efficiency, and must be able to do so without causing serious complications such as bleeding.
If venous thrombosis is not suspected, undiagnosed and untreated, or is insufficiently or inappropriately treated, the risk of pulmonary embolism becomes very high.
How to prevent thrombosis diseases
Thrombotic diseases affect twice as many cancers and are the leading cause of death and severe disability in so-called industrialized countries. But, they could be prevented in at least one in three cases.
To prevent thrombosis diseases, all of us should know the risk factors that increase their likelihood, and commit ourselves to changing those that depend on us and our lifestyle choices.
In fact, the prevention of thrombosis diseases depends on a team composed of:
- informed and motivated patient
- experienced doctor
- medicines available.
Thus, lifestyle is a key element in increasing probability when it is out of control, and in reducing it when it is based on intelligent choices.
It is fundamental in healthy people, and even more essential in those who have already been affected: and it is the patient’s responsibility.
Instead, the physician’s responsibility is to choose the most suitable drugs for the individual patient and their history, and to motivate the patient to follow the therapy with discipline and correct the risk factors that increase the probability of events.
Therefore, the responsibility of the patient or their caregiver is to strictly follow the doctor’s instructions and take the necessary measures to correct:
- overweight and obesity
- dangerous habits such as cigarette smoking
- excess stress
- diet too high in fat
It is also essential to treat hypertension and diabetes accurately.
Venous thrombosis: how to prevent and not relapse
To avoid venous thrombosis, the patient must be very disciplined and use the medications according to the doctor’s instructions. This, in order to avoid pulmonary embolism but also post phlebitic syndrome , a consequence of repeated thrombosis and not treated adequately.
In fact, this syndrome makes life very complicated due to ulcers that form on the legs and often become infected and do not heal: it occurs especially after repeated venous thrombosis in the veins of the legs.
Diet to prevent thrombosis diseases
A healthy lifestyle is essential to reduce the risk of many diseases, including thrombosis. Here are what behaviors to adopt and which ones to avoid.
First of all, eat healthily, which means:
- less saturated fat;
- limit salt: no more than one teaspoon per day;
- fish: at least three times a week;
- less red meat, more white meat;
- vegetables and fruit: five servings a day;
- limit fried foods and packaged baked goods.
Red wine and beer contain an antioxidant substance called resveratrol. This substance develops its “anti-rust” action on the walls of the arteries only if these drinks are consumed together with a meal and in moderate quantities:
- 1/2 glasses a day for women;
- 2/3 glasses a day for men.
On the other hand, spirits, in addition to not giving this protection, are harmful to the brain, increase the risk of cerebral haemorrhage and in large quantities are toxic to the liver.
Preventive parameters to keep under control
In addition to having a healthy lifestyle that reduces the risk of thrombosis and many other diseases, the following parameters should be kept under control:
- keep blood sugar, cholesterol and triglycerides under control
- measure the waistline and reduce weight if excessive
- periodically measure blood pressure and take antihypertensive medications carefully if advised by your doctor.
Prevention and lifestyle
Here is what can be done and what a patient must do to avoid relapse:
- wearing elastic stockings for an extended time, up to 2 years or more. They are worn in the morning after keeping the legs raised against the headboard of the bed, performing some exercises of rotation of the ankles and contraction of the calves: the legs become pale, signaling that the veins are returning blood to the heart, and should be worn all day , everyday.
- Place two 15 cm supports under the foot of the bed or bed base , such as two bricks or two old books, so that during the night the blood returns to the heart more quickly and does not stagnate in the veins of the legs.
- Respect a daily physical activity program , each one according to their possibilities and abilities, such as walking at a relatively fast pace, cycling, swimming, dancing. In fact, during physical activity the muscles of the legs contract and help the blood to return quickly to the heart.
- Avoid exposing your legs to the sun during the hottest hours or too close to direct heat sources such as stoves or fireplaces.
- Take the drugs prescribed by the doctor in the times and doses indicated, respecting the times.
- Avoid staying too long in pied i, especially without stockings. If it cannot be avoided, then squeeze your calves, shift your weight from one leg to the other, and lift yourself up onto your ankles.
Very Important : Some oral anticoagulant drugs, such as dicumarols, can harm the fetus in the early stages of pregnancy .
So it is important to warn your doctor if you are planning a pregnancy while taking dicumarol.
Nutrition and anticoagulant drugs
Among anticoagulant drugs, dicumarolics are affected by the consumption of foods very rich in vitamin K. But, interference with the beneficial effect of the drug is manifested only by the consumption of at least 100 grams of each of the following foods:
- cabbage, broccoli, cauliflower, turnip greens, savoy cabbage, sauerkraut
- calf liver
- soy and soy foods.
Natural remedies to prevent thrombosis
Omega-3 supplements, which are cod liver oil extracts , contain eicosapentaenoic acid, a substance that has a natural and mild antiplatelet action on platelets.
They are not drugs, but supplements that can help maintain blood fluidity in situations where a proper antithrombotic drug is not needed.
In addition, they help reduce blood triglyceride levels, do not interfere with other drugs in use, and do not cause bleeding.
Association for the fight against thrombosis
The President of the ALT non-profit organization, Dr. Lidia Rota Vender , describes the Association’s program and objectives as follows:
“The prevention of thrombosis diseases is possible and necessary: they are an announced epidemic, growing very rapidly in the next twenty years.
No government will be able to withstand the economic impact that these diseases will have on individual states, in terms of health costs, to treat those who have been affected and assist those who have been seriously disabled.
And no family will want to suffer the loss of a loved one knowing that something could be done to prevent it.
Saving 200,000 Italians from thrombotic diseases every year is a possible mission . But to get closer or to reach this goal it is essential that each of us take the responsibility of knowing thrombosis diseases so as not to have to meet them one day.
This is why ALT works, to make sure that no one will one day say “I didn’t know”.
With the advice of Specialists in Hematology and Cardiovascular Diseases from Thrombosis