When we speak of blood clots there is both the good news and the bad news. The good news is that blood does indeed clot. Without this ability, we humans would not have survived long on this planet.
The bad news is that sometimes blood clots can form in places they are not wanted. Major health consequences, including death, can be the result.
Traditional Clot Treatments
Most people are familiar with the concept of a heart attack caused by the sudden appearance of a blood clot that forms behind an obstruction in an artery in the heart. First line treatment today usually involves rapid transfer of the patient to the “Cath Lab” where the Cardiologist then identifies the artery that is occluded and opens it up with a dilating balloon catheter.
A stent is often placed and clot busting drugs may or may not be used. If the blockage is not treatable in this way, then emergency open heart surgery may be needed to construct a coronary [heart] artery bypass in order to save the heart muscle.
Other arterial clots are treated in much the same way. The Vascular Surgeon uses catheter techniques to open the vessel and if this is not possible then open surgery can be performed. These techniques have been around for several years now and really cannot be called new.
The Dangers of Venous System Clots
However, on the venous side of the circulation things are a bit different. Clots of significance on the venous side do occur, and the ones in the large veins below the diaphragm are the most common. There are multiple causes for venous clot formation, but that is a subject for another day.
Clot formation in the venous system is dangerous. Since the veins return blood to the heart, if a piece of clot breaks off and enters the circulation, it will pass through the heart and go directly to the lungs—a so called pulmonary embolus [PE]. If large enough this can kill the patient.
Excessive clot formation in the large veins of the legs and pelvis obstruct the veins and cause pooling of the blood behind the clot. This stagnation of flow favors more clot formation. Similarly, stagnation occurs directly in front of the clot, favoring yet more clot formation.
This stagnation of flow is deleterious to the tissues involved. It also destroys the delicate one way valves that are present in all veins from the groin on down. After the acute episode has resolved, the patient is usually left with residual scaring and blockage as well as incompetent vein valves. This condition results in long term problems in the lower extremities.
New Treatments for Blood Clots
For years physicians had really only on basic treatment. I was taught in medical school and also in my vascular training to hospitalize these patients, elevate their legs, and begin heparin IV. Heparin is an anticoagulant which prevents further clotting. The common misconception is that it is a “clot buster”. It is not. In the past we had to rely on the body’s natural clot busters to break up the clot while we prevented new clot formation with heparin.
Scientific advancement has added tools to the physician’s treatment tool box:
The first new tool is Lovenox. This is an injectable heparin that is long acting. This allows patients to be immediately anticoagulated without hospitalization.
The newer medical support hose with graduated compression gives better support and helps prevent stagnation of the blood allowing patients to be ambulatory.
The next tool is the development of clot busters. These drugs do what their name implies; they attack the clot and break it down.
Using Medications and Machines to Effectively Treat Clots
For some time now we have had the ability to place via catheters, inferior vena cava [IVC] filters. The IVC is the vein super highway that leads directly to the heart. In certain patients these filters are placed to catch broken off clots and prevent them from migrating to the lungs.
The development of catheters which could deliver a clot buster directly into the clot itself was the next development. This was followed by devices which could mechanically break up the clot. When these 2 methods are combined, we have a system that can use both medicine and mechanics to minimize or eliminate the clot quickly, thus preserving the venous valves and minimizing both the short term and the long term effects of a large clot.
There is a slight increased risk of knocking clot loose with these treatments and we now have IVC filters that are removable. They can be put in when the risk of PE is high and later removed when that risk is under control.
These on going advancements allow Vascular specialists to treat clotting problems in the best manner possible depending on the situation. It should be mentioned that ALL these new “tools” have their own set of potential complications. The Vascular specialist will be aware of these and can advise the patient in order to obtain the best result.
Dr. Robert Ruess is the Vein Specialist at Five Star Vein Institute. Schedule your free vein screening at one of their locations in Las Vegas or Mesquite, Nevada. Visit www.fivestarvein.com for more information.