What Is Excessive Blood Clotting (Hypercoagulation)?

When you get a cut or wound, your body forms blood clots, a thickened mass of blood tissue, to help stop the bleeding. Proteins in your blood called fibrins work with small blood cell fragments called platelets, to form the clot. This is called coagulation, a process that helps the body when an injury occurs because it slows blood loss.

After bleeding has stopped and healing has occurred, the body should break down and remove the clots. But sometimes blood clots form too easily or don’t dissolve properly and travel through the body limiting or blocking blood flow.

This is called excessive blood clotting or hypercoagulation, and can be very dangerous. In a case of excessive blood clotting, these clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs and limbs, which in turn can cause heart attack, stroke, damage to the body’s organs or even death.

Many factors can cause excessive blood clotting including certain diseases and conditions, genetic mutations and medicines. These causes fall into two categories: acquired and genetic.

• Acquired means that excessive blood clotting was triggered by another disease or condition. Smoking, overweight and obesity, pregnancy, use of birth control pills or hormone replacement therapy, cancer, prolonged bed rest, or car or plane trips are a few examples.
• The genetic, or inherited, source of excessive blood clotting is less common and is usually due to genetic defects. These defects usually occur in the proteins needed for blood clotting and can also occur with the substances that delay or dissolve blood clots.

Acquired and genetic sources of excessive blood clotting are not related but a person can have both.

Some other names for excessive blood clotting are:

• Hypercoagulable disorders or states
• Hypercoagulation
• Thromboembolic states
• Thrombophilia (a name used mainly for genetic conditions)
• Thrombotic disorders

Why Excessive Blood Clotting Matters

The outlook and treatment for excessive blood clotting depend on the cause of the blood clots, how severe they are, and how well they can be controlled.

Some Possible Effects of Blood Clots Include:

• Stroke – A stroke can occur if a blood clot causes blood flow to your brain to be restricted. If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control. A stroke can cause lasting brain damage, long-term disability, paralysis (an inability to move), or death.
• Heart Attack – A blood clot in a coronary artery can lead to a heart attack. A heart attack occurs if blood flow to a section of heart muscle becomes blocked. If blood flow isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die. This heart damage may not be obvious, or it may cause severe or long-lasting problems such as heart failure or arrhythmias.
• Kidney Failure – A blood clot in the kidneys can lead to kidney failure, where kidneys can no longer remove fluids and waste from your body.
• Pulmonary Embolism – If a blood clot travels from a deep vein in the body to the lungs, it’s called a pulmonary embolism (PE). PE is a serious condition that can damage your lungs and other organs and cause l ow oxygen levels in your blood.
• Deep Vein Thrombosis – A blood clot in a vein deep in your arm or leg can cause pain, swelling, redness, or increased warmth in the affected limb can cause deep vein thrombosis (DVT). DVT clots can break off, travel to the lungs and cause PE.
• Venous Thromboembolism (VTE) – Together, PE and DVT make up venous thromboembolism.
• Peripheral Artery Disease (PAD) –  PAD is a narrowing of the peripheral arteries, most commonly in the arteries of the pelvis and legs.
• Pregnancy-related problems – Blood clots can cause miscarriages, stillbirths, and other pregnancy-related problems, such as preeclampsia, which is high blood pressure that occurs during pregnancy.

With medicines and ongoing care, many people who have excessive blood clotting can successfully manage it.

Blood Clotting, COVID-19 and Vaccines

Jul 07, 2021 9:00 AM

Author:
Kylene Metzger

A blood clot is a collection of blood cells and coagulation proteins that clump together, forming a gel-like substance in the blood system that can obstruct blood flow. Blood clots are often triggered by certain events such as injuries, surgeries, or infections. Since the beginning of the COVID-19 pandemic, blood clotting has been identified as a side effect of SARS-CoV-2 and later as an extremely rare side effect of some COVID-19 vaccines.

Yazan Abou-Ismail, MD, a hematologist at University of Utah Health, answered questions about the association of blood clots with COVID-19 and certain vaccines.

Where do blood clots occur?

Deep venous thrombosis (DVT) occurs when a blood clot forms in the deep veins of your body, usually in the lower leg, thigh, or pelvis. A blood clot that travels from the deep veins and blocks one of the arteries in your lungs is called a pulmonary embolism (PE). Both medical conditions may be life-threatening, but are preventable and treatable if discovered early.  In the U.S. each year, about 900,000 people experience a blood clot and 100,000 people die from blood clots.

What is the link between blood clots and COVID-19?

The association between COVID-19 and blood clots was recognized early in the pandemic among hospitalized COVID-19 patients. These patients experienced blood clots both in deep veins and arteries, which sometimes led to strokes and heart attacks. Although these conditions have mostly been seen in patients with severe COVID-19 illness, people with moderate illness have also developed blood clots. Data from the beginning of the pandemic indicated that the incidence of blood clots in severe COVID-19 illness ranged from 20 to 40 percent. The incidence in people with mild or moderate COVID-19 illness was three to nine percent.

Do certain people have a higher risk for developing blood clots if they have COVID-19?

Patients who develop blood clots as a result of COVID-19 infection usually have severe COVID-19 illness (hospitalized in the ICU), respiratory failure, require high amounts of oxygen, or have other underlying illnesses. Other underlying risks for blood clots include patients with a previous medical history of blood clots or a hereditary blood clotting disorder. Those who have hypertension, diabetes, are obese, or have cancer are also at higher risk.

What is the association between blood clotting and certain COVID-19 vaccines?

Some COVID-19 vaccines are associated with an extremely rare syndrome known as vaccine-induced thrombotic thrombocytopenia (VITT). It was discovered in March 2021 in connection to the AstraZeneca COVID-19 vaccine and then later with the Johnson & Johnson COVID-19 vaccine. In rare cases, antibodies that the body produces as a side effect of the vaccine lead to uncontrolled activation of platelets. This causes both low platelet counts and blood clots to form in unusual areas. VITT is not associated with the Moderna or Pfizer-BioNTech mRNA vaccines. 

According to the CDC, as of June 30, 2021, there have been 35 confirmed reports of VITT in connection to the J&J vaccine out of more than 12 million doses that have been administered in the U.S. In the United Kingdom, there are more than 300 confirmed cases of VITT connected to the AstraZeneca vaccine. Although VITT is extremely rare, it is a serious and treatable condition. Doctors now know how to recognize and treat VITT, and patients who receive the J&J vaccine are informed how to recognize its side effects.

What are symptoms of VITT?

Symptoms of VITT include:

• Severe or persistent headaches
• Chest pain
• Trouble breathing
• Leg swelling/pain
• Severe abdominal pain
• Confusion
• Vision changes
• Seizures

Anyone experiencing these symptoms within four weeks of vaccination should contact their health care provider or seek immediate medical attention.

What data backs up the fact that VITT is an extremely rare side effect?

Out of more than 12.5 million people who received the J&J vaccine in the U.S., 35 cases have been reported to the CDC. That’s an incidence of two to three cases per million. Both men and women can get VITT but women between the ages of 20 to 50 are at a higher risk of experiencing VITT from the J&J vaccine. In this group, the incidence is about 10 per million, which is also still extremely rare.

The benefits of vaccination outweigh these rare potential risks. The CDC has estimated that every million doses prevent between 60 to 140 deaths and 400 to 1,000 hospitalizations from COVID-19.

Is it possible to experience blood clots months after having COVID-19 or getting a COVID-19 vaccine?

Based on current information available about VITT, there is no evidence that blood clotting could occur more than four weeks after getting vaccinated. However, blood clotting is possible months after having COVID-19 for patients who have had long hospitalizations, had surgery, are immobilized, or have a history of underlying health conditions such as obesity, diabetes, or blood clots. This is variable based on the patient and length of illness.

What do you tell your patients?

Whenever something like VITT happens, it causes the public to worry. We need to remember that COVID-19 vaccines are very effective at protecting against COVID-19. What I tell my patients is you have to weigh the risks and benefits. The risk of developing serious side effects from COVID-19 vaccines is extremely unlikely. Getting infected with COVID-19 has a much higher risk of complications, such as blood clots, long-term symptoms, and even death.

Where can I learn more?

After years of decline, death rate from lung clots on the rise

(doyota/iStock, Getty Images)

After nearly a decade of steady decline, the death rate for people with blood clots in the lungs reversed course and began rising over the past decade, new research finds.

The study, published Monday in the Journal of the American Heart Association, found death rates for pulmonary embolism (PE) dropped an average of 4. 4% per year from 1999 to 2008, then began climbing an average of 0.6% per year. The biggest increases were for people under age 65.

“Death rates for PE are rising and seem to be doing so across age, race and geographic regions,” said lead author Dr. Karlyn Martin. She is assistant professor of medicine in the division of hematology/oncology at Northwestern University’s Feinberg School of Medicine in Chicago.

Pulmonary embolism is part of the broader disease called venous thromboembolism (VTE), or blood clots that start in the veins. VTE also includes deep vein thrombosis (DVT), a clot in a vein deep in the body, usually the leg. If such a clot breaks free, it can travel to the lungs and cause a pulmonary embolism.

There were roughly 370,000 PE and 857,000 DVT events in the United States in 2016, the last year for which data are available, according to American Heart Association statistics. PE and DVT kill up to 100,000 Americans each year, says the Centers for Disease Control and Prevention.

“We know that (PE and DVT) are more common as people get older,” Martin said. “So, we expected there to be higher rates in older people. But we found a significant number of younger people dying from PE as well. We don’t know what’s causing it, but it’s a worrisome trend that needs dedicated study to find out why.”

The researchers found premature and preventable deaths from pulmonary embolism increased 23% from 2008 to 2018 among people ages 25 to 64, a trend that mirrors a rise in deaths from all causes among this age group.

While white men showed the highest increase in PE mortality rates, the death rate for Black men and women was consistently higher than that of white people over the past two decades, the study found. As with the change in mortality rates, the study did not address why racial disparities existed.

“These data, for the first time, describe an alarming trend that is impacting Black Americans in particular,” said Dr. Mary Cushman, medical director of the Thrombosis and Hemostasis Program at the University of Vermont Medical Center. She was not involved in the study.

“It is very hard to determine the cause, apart from speculation,” said Cushman. She chaired the writing group for a recent scientific statement from the AHA and International Society on Thrombosis and Haemostasis that pinpointed future research priorities in VTE.

Cushman led prior research that found severe obesity to be a stronger risk factor for pulmonary embolism than DVT, suggesting “the continued rise in obesity may be playing a role. Other lifestyle factors like sedentary behavior, which is also on the rise, might be at play,” she said. “But the rising rate in younger adults is a mystery to me and requires further study.”

She called the study “a wake-up call that we are going in the wrong direction.”

That means current efforts to prevent or treat pulmonary embolism don’t seem to be working to keep death rates down, Martin said. “We need to know what’s underlying the drivers to prevent this and stop it from rising further. “

If you have questions or comments about this story, please email [email protected].

What You Need to Know > News > Yale Medicine

[Originally published: April 21, 2021. Updated: August 4, 2021]

In the minds of many, the almost two-week halt of the Johnson & Johnson vaccine in April delivered doubt just as the mass COVID-19 vaccinations were making progress. There are three vaccines authorized for use in the United States, but Johnson & Johnson’s is a particularly important one, partly because its one-shot dose could help achieve herd immunity faster. In early April, the government recommended pausing the company’s vaccine after six women who received it developed rare blood clots—and one woman died.

But in late April, the Food and Drug Administration (FDA) decided to add a warning label about an uncommon, but potentially serious, blood clotting disorder. This decision followed a vote by a panel of advisers to the Centers for Disease Control and Prevention (CDC) to end the pause. This clears the way for states to resume vaccinations with the Johnson & Johnson vaccine.

Six cases is a small number, considering that over 6.8 million Johnson & Johnson shots had been administered as of April 12. (By May, 9 million doses had been administered and the number of rare blood clot cases had grown to 28, six of them in men, according to the CDC. At that point, three people had died.) 

So, why did the pause occur?

Focusing on the word “pause” is key to understanding what happened with the Johnson & Johnson vaccine. “Putting a pause on a new vaccine or medication is not unusual. Even after it has completed its clinical trials, a vaccine still must be monitored in the real world,” says Yale Medicine infectious diseases specialist Jaimie Meyer, MD, MS. “If there are serious adverse events, we need to stop, take a deep breath, collect and analyze the data—and really try to understand why this is happening. Then, we can decide whether we should proceed.”

Transparency is also important, Dr. Meyer adds. “People should know that there are these events that have been observed—even if they are very rare events—so they can make informed choices,” she says.

Every five minutes someone dies from a blood clot or deep vein thrombosis — ScienceDaily

Each year between 100,000-180,000 Americans die as the result of pulmonary embolism, a complication from blood clots in the lungs. The Vascular Disease Foundation urges Americans, especially women, to learn about the risks of venous blood clots to help prevent these deaths. While men and women are at equal risk, the risk for deep vein thrombosis, or blood clots, varies depending on where a woman is in her lifecycle, her hormone levels, and if she has a family history of clotting disorders.

DVT occurs when a blood clot forms in the deep veins, usually of the pelvis or leg. DVT can be dangerous in two ways. First, DVT can be fatal if a blood clot breaks free from the leg veins and travels through the heart and lodges in the lung arteries. This complication, called pulmonary embolism (PE), causes between 100,000 and 180,000 deaths per year in the United States. Second, because blood clots can permanently damage the veins, as many as half of DVT survivors can experience long-term leg pain, heaviness and swelling that can progress to difficulty in walking, changes in skin color and open leg sores (known as ulcers). This condition, called post-thrombotic syndrome (PTS) or “chronic venous insufficiency,” can significantly impair quality of life.

Certain individuals may be at greater risk for developing DVT, but it can occur in almost anyone. Risk factors or triggering events that are more likely to affect women include pregnancy and the six to eight weeks after giving birth, the use of birth control pills or postmenopausal hormone replacement therapy, cancer and its treatment, and major surgery.

Anyone may be at risk for DVT but the more risk factors you have, the greater your chances are of developing it. Knowing your risk factors gives you the chance to do something about it:

• Hospitalization for a medical illness or any illness
• Recent major surgery (especially orthopedic surgery) or injury or trauma
• Personal history of a clotting disorder or previous DVT
• Increasing age
• Cancer and their treatments
• Family history of DVT
• Extended bed rest
• Obesity
• Smoking
• Prolonged sitting when traveling (longer than 6 to 8 hours)

DVT and PE should be considered emergencies that require immediate care if any of the following symptoms are present:

Symptoms of Possible DVT:

• Recent swelling of one leg Unexplained pain or tenderness of one leg Change in skin color or skin is hot to the touch

Symptoms of Possible PE:

• Recent or sudden shortness of breath Sharp chest pain, especially when breathing in Coughing up blood or sudden collapse

“Every year, more people die from preventable blood clots than from breast cancer, AIDS and traffic accidents combined,” said Dr. Samuel Goldhaber, Chairman of the Venous Disease Coalition. “It is so important to raise awareness about DVT and PE because although blood clots are common, few Americans have sufficient knowledge about blood clots and how to prevent them.”

Story Source:

Materials provided by Vascular Disease Foundation. Note: Content may be edited for style and length.

COVID-19 Infection Combined with Blood Clots Worsen Patient Outcomes

​While respiratory issues continue to be the most common symptom of a COVID-19 infection, new research indicates the disease could also be associated with hypercoagulability, or increased tendency of the blood to clot. In a new study published November 20, 2020 in the journal EClinical Medicine by The Lancet, researchers from UC San Diego Health found that blood clots led to an increased risk of death by 74 percent.

An illustrator’s rendition of thromboembolism, or blood clot. Photo credit: Getty Images

Led by Mahmoud Malas, MD, division chief of Vascular and Endovascular Surgery at UC San Diego Health, researchers reviewed 42 different studies involving more than 8,000 patients diagnosed with COVID-19. Using random models, the team produced summary rates and odds ratios of mortality in COVID-19 patients with thromboembolism, blood clots — and compared them to patients without these conditions to determine what effect blood clots may have on risk of death.

“We began to notice a really unusual manifestation of venous and arterial thromboembolism in patients with COVID-19,” said Malas. “In addition to higher instances of blood clots, the mortality for patients hospitalized for COVID-19 and with thromboembolism was much higher, compared to patients without clots. It’s unusual because we have never seen anything like this with other respiratory infections.”

Overall, 20 percent of the COVID-19 patients were found to have blood clots in the veins, and among patients in the intensive care unit, that statistic increased to 31 percent.

Blood clots in the vein, or deep vein thrombosis, can reach the lungs and develop into pulmonary embolism, resulting in higher risk of death. Blood clots in the arteries may lead to limb amputation if not treated surgically in a timely fashion. 

Mahmoud Malas, MD, division chief of Vascular and Endovascular Surgery at UC San Diego Health.

In the study, Malas and colleagues performed a systemic review through meta-analysis, which is a statistical method that allowed researchers to combine multiple studies to produce a single comprehensive paper.

“The collective experience in the literature as captured in this meta-analysis study brings additional light on the importance of blood vessel clotting events in hospitalized patients with COVID-19,” said Bryan Clary, MD, surgeon-in-chief at UC San Diego Health and co-author of the study. “While the frequency of these events is much higher than expected, our study likely underestimates the incidence of thromboembolism in the global population of patients with COVID-19, including non-hospitalized patients.”

According to Malas, arterial blood clots developing in people with the flu is extremely rare, and the rate of clotting in patients with COVID-19 is higher than what is reported for other viral pandemics, including the h2N1 influenza of 2009.

Similar symptoms are shared between influenza and SARS-CoV-2, such as fever, cough, shortness of breath, or fatigue. Blood clotting can occur in patients hospitalized with the flu, but only in veins. For patients with COVID-19, blood clots can appear in either veins or arteries.

Bryan Clary, MD, surgeon-in-chief at UC San Diego Health.

Typically, clotting in the arteries is caused by health factors, such as atrial fibrillation, high blood pressure, high cholesterol, diabetes, or lifestyle choices like smoking. Patients who are hospitalized for long periods of time are also more at risk for blood clots in the vein due to immobility.

Blood clots in the vein are treated or prevented with prescribed blood thinners. Proactively administering such medications to hospitalized patients can also help prevent clots from forming. Clinical trials are ongoing to determine how blood thinners can reduce the risk of clotting in patients with COVID-19.

“What we can learn from this paper is due diligence,” said Malas. “We’re still in the process of understanding the pathophysiology of COVID-19, so it’s important to have a low index of suspicion when it comes to this infection to ensure we’re doing all we can to mitigate the spread and prevent severe outcomes.”

Co-authors include: Isaac N. Naazie, MD, MPH, Nadin Elsayed, MD, Asma Mahlouthi, MD, and Rebecca Marmor, MD, all at UC San Diego.

No funding was reported for this study.

CDC says 28 blood clot cases, 3 deaths may be linked to J&J Covid vaccine

The Johnson & Johnson Janssen Vaccine

Stephen Zenner | LightRocket | Getty Images

CDC scientists say their investigation into a rare blood clotting issue linked to the Johnson & Johnson Covid-19 vaccine has identified 28 people who developed the potentially life threatening blockages — three of whom have died.

The Food and Drug Administration and Centers for Disease Control and Prevention on April 13 asked states to temporarily halt using J&J’s vaccine “out of an abundance of caution” while it investigated six women, ages 18 to 48, who developed cerebral venous sinus thrombosis, or CVST, in combination with low blood platelets within about two weeks of receiving the shot.

They recommended resuming use of the shot 10 days later after the CDC determined that the benefits of the inoculations outweighed their risks.

CVST is a form of thrombosis with thrombocytopenia, or TTS, which are blood clots with a low platelet count that puts patients at risk for a stroke. Platelets actually help the blood to clot.

CDC official Dr. Tom Shimabukuro said Wednesday that four of the 28 people with TTS remained in the hospital as of May 7, one of whom was in the ICU, and two have been discharged to a post-acute care facility. The remaining 19 patients have all been discharged, he said during a presentation to the CDC’s Advisory Committee on Immunization Practices. The panel voted earlier in the day to recommend the Pfizer-BioNTech vaccine for use in 12- to 15-year olds.

The median age of the patients with TTS was 40, ranging from 18 to 59 years old. Women who were 30 to 39 years old accounted for the biggest risk group. All of the patients received the J&J shot before the pause on April 13. Out of the 28 TTS cases, 19 affected the brain with 10 of those patients suffering from a cerebral hemorrhage, Shimabukuro said.

The other clots formed in the lower extremities, pulmonary arteries or other areas of the body.

90,000 Doctors warn about the risk of death from thrombosis in coronavirus

Thrombosis, which occurs in patients with a new type of coronavirus infection, can lead to heart attack, stroke or gangrene, Russian doctors told Gazeta.Ru. According to experts, among the causes of blood thickening are a sharp immune response to inflammation in the body, autoimmune diseases, as well as a person’s lifestyle: low physical activity, bad habits and poor nutrition.

With a new type of coronavirus infection, blood clots form in patients, due to which doctors are forced to amputate limbs.This is reported by “Novaya Gazeta” with reference to the doctor of the Moscow City Clinical Hospital No. 15 named after Filatov Viktor Anosov.

“Thrombus in the head – stroke, in the heart – infarction, in the lungs – pulmonary embolism. It’s easier with limbs. Amputations take place every day, ”Anosov said. He noted that blood clots form in all patients with COVID-19, as this is a common complication in the new type of coronavirus.

The D-dimer indicator, which shows the body’s tendency to thrombosis, should normally be 1-2 nanograms per milliliter of blood, maximum 500, while in patients with coronavirus, as indicated by the doctor, this figure reaches 1-7 thousand.

However, phlebologist Dmitry Rodnin did not agree with his colleague. It cannot be argued that blood clots can form in all patients, the physician told Gazeta.Ru. According to him, this applies only to certain categories of patients.

“Strange statement. If we are talking about a risk group and people who lead an inactive lifestyle, then yes. Because in their case, the blood is not enriched with oxygen as it is necessary for a healthy body. Or it concerns those who went to the doctor late and their condition has already reached a serious one, ”the doctor says.

He recalled that in the first 3-7 days, a patient with COVID-19 is given antiviral therapy, then he is given medications in therapeutic doses to reduce the risk of thrombosis.

“In many people, the virus, when it enters the body, causes an overly strong immune response. As a result, the level of platelets in the blood rises sharply – they are responsible for blood clotting. Moreover, if a person is unable to walk due to their general condition, the risk of thrombosis increases, ”the specialist explained.

Rodnin specified that in his practice there was a 47-year-old patient with COVID-19, whose heart was damaged during the course of the disease. Due to inflammation and a sharp increase in platelet levels, the muscle tissue of the heart has become deformed, as happens with a heart attack.

In early November 2020, physicians from the Michigan Frankel Heart Center identified another cause of increased blood clotting, which occurs in almost half of patients with COVID-19 and significantly worsens their condition.

As the study showed, such consequences are caused by autoimmune antibodies that attack cells – in this process, blood clots are formed in arteries, veins and blood vessels.

These clots can restrict blood supply to the lungs, disrupting oxygen metabolism. In turn, immunologist Tatyana Drakova noted that sex hormones also affect the formation of blood clots – because of this, men are more likely to suffer from COVID-19 in a severe form.

“The fact is that in men the main sex hormone is testosterone, in women – estrogen.It is estrogens that allow protective proteins to quickly enter the cell and prevent the formation of clots in the blood, as well as destroy the virus faster, ”she explained to Gazeta.Ru.

Moreover, men are more at risk of thrombosis due to a number of factors: bad habits, lack of physical activity, poor diet and a tendency to problems with blood vessels. The physician notes that, according to her observations, people over 35 years old face such manifestations.

Hematologist Olga Surnina told “Gazeta.Ru ”that anticoagulants, that is, drugs that thin the blood, are necessary for patients with a new coronavirus infection. They should be taken both during the acute phase of the disease and after recovery.

“They are prescribed to patients with moderate and severe COVID-19, each patient has its own dosage. Doctors prescribe the same drugs after being discharged from the infectious diseases department, but many neglect therapy, ”the doctor said.

She emphasized that even after recovery, it takes a long time to recover the lungs, which are mainly affected by the coronavirus.In order to dissolve microthrombi that may have formed in the lungs, it is necessary to take blood-thinning drugs.

“At the same time, drugs can be canceled only after repeated tests – when the platelets return to normal. In the event that a patient who is at risk, himself cancels therapy, there is a risk of stroke, heart attack or gangrene, which can lead to death, ”concluded Surnina.

90,000 Blood thinners for long-term treatment of thrombosis in patients with cancer

Relevance

Patients with cancer are at increased risk of developing thrombosis and may respond differently to different types of blood thinners (anticoagulants).

Research characteristics

We searched scientific databases for clinical trials examining the effect of long-term treatment with various anticoagulants on recurrent thrombus formation in people with cancer with a confirmed diagnosis of deep vein thrombosis (blood clots – blood clots in the legs) or pulmonary artery thrombosis (blood clots – blood clots in the lungs) … We included trials with any type of cancer, and regardless of the type of cancer treatment. The trials assessed survival, recurrence of thrombosis, bleeding, and the level of platelets in the blood (which are involved in the blood clotting process).The evidence was current to May 2018.

Key Findings

We found 16 studies, with a total of 5167 participants, with cancer and blood clots. Studies have shown that low molecular weight heparins (LMWH, a type of blood thinning agent given by injection into a vein) were superior to vitamin K antagonists (VKA, a type of blood thinning agent used orally, by mouth) in reducing the recurrence of thrombosis. The available data did not provide a clear answer to the question about the effect of these drugs on death and side effects in the form of bleeding.Research has also shown that direct oral anticoagulants (PAD; another type of blood thinning agent taken by mouth, taken by mouth) can reduce the recurrence of thrombosis compared to LMWH while increasing the risk of bleeding. There was no clear answer to the question of efficacy when comparing PPA (a newer type of oral blood thinner) and AVK (an older type of oral blood thinner) for death, recurrent thrombosis and bleeding.

Strength of Evidence

When comparing LMWH to VKA, we rated the certainty of evidence as moderate for recurrent thrombosis, death within one year, and major bleeding, and low for minor bleeding.

When comparing PPA with VKA, we rated the certainty of the evidence as low for death, recurrent thrombosis, and bleeding complications.

Editor’s Note: This is a live systematic review. Live systematic reviews offer a new approach to review updates in which the review is continually updated to include relevant new evidence as it becomes available. Please refer to the Cochrane Systematic Review Database for the current status of this review.

Scientists have found a way to reduce mortality from coronavirus

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Scientists have found a way to reduce mortality from coronavirus

Scientists have found a way to reduce mortality from coronavirus – RIA Novosti, 05/18/2020

Scientists have found a way to reduce deaths from coronavirus

Death from coronavirus can be prevented with blood-thinning drugs, scientists from Britain say. The newspaper The Telegraph writes about it.RIA Novosti, 18.05.2020

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MOSCOW, May 18 – RIA Novosti. Death from coronavirus can be prevented by using blood-thinning drugs, according to scientists from Britain. According to the newspaper The Telegraph. Specialists from the Royal Brompton Hospital reported that they found a link between blood clotting and COVID-19. Doctors examined the lungs of critically ill patients and found them lack of blood flow, which indicated thickening of blood in small vessels. At the same time, many deaths from coronavirus are accompanied by a lack of oxygen in the body.Earlier, experts from University College London reported blood clots in some of the deaths from the coronavirus. Blood clots in different parts of the body have even led to strokes, the researchers noted. The National Health Service of England intends to soon recommend the use of anticoagulants (blood-thinning drugs – Ed.) For patients in critical condition. Doctors hope to save many lives in this way. Professor Peter Openshaw of the Government’s Science Council believes the scientists’ findings could be a breakthrough in understanding the signs of oxygen deficiency.The coronavirus pandemic has spread to almost every country in the world. According to the WHO, a total of about 4.6 million people are infected, of which more than 311 thousand have died, and the UK is among the leaders in the number of infections and deaths from coronavirus. The country has recorded over 243 thousand infected, of which almost 35 thousand have died.

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in the world, UK, who, discoveries – RIA Science, coronavirus covid-19

MOSCOW, May 18 – RIA Novosti. Death from coronavirus can be prevented with blood-thinning drugs, UK scientists say. The newspaper The Telegraph writes about it.

Experts from the Royal Brompton Hospital reported that they found a link between blood clotting and COVID-19.

Doctors examined the lungs of critically ill patients and found that they did not have blood flow, indicating a thickening of blood in small vessels.At the same time, many deaths from coronavirus are accompanied by a lack of oxygen in the body.

Earlier, experts from University College London reported blood clots in some of the deaths from coronavirus. Blood clots in different parts of the body have even led to strokes, the researchers noted.

18 May 2020, 17:33 Spread of coronavirus Popular myth about coronavirus dispelled

The National Health Service of England intends to recommend the use of anticoagulants (blood thinning drugs.- Approx. ed.) for critically ill patients. Doctors hope to save many lives in this way.

Professor Peter Openshaw of the Government’s Science Council believes that the scientists’ discoveries could be a breakthrough in understanding the signs of oxygen deficiency.

The coronavirus pandemic has spread to almost all countries in the world. According to the WHO, a total of about 4.6 million people are infected, of which more than 311 thousand have died, and the UK is among the leaders in the number of infections and deaths from coronavirus.More than 243 thousand infected people were recorded in the country, of which almost 35 thousand died.

Possible complications

Ignoring the symptoms of minor hemoptysis can lead to the development of massive bleeding. It causes the airways to fill with blood, which blocks access to air.As a result, death from asphyxia (suffocation) can occur. A lethal outcome is also possible with profuse blood loss, amounting to about 4–4.5% of the total body weight.

If untreated, the disease that caused hemoptysis continues to progress and cause complications. With cancer, metastases appear, with pneumonia and tuberculosis – fibrosis of the lung tissue, with bronchiectasis – bleeding, abscess, heart attack and lung necrosis.

What causes hemoptysis in cancer

95% of blood enters the lungs through the pulmonary arteries, which have low pressure.Having reached the capillary bed, it gives off carbon dioxide and is saturated with oxygen. The rest of the blood (5%) enters the lungs through the bronchial arteries, which have high pressure. It nourishes the respiratory and respiratory tract. Hemoptysis is characterized by bleeding from the bronchial arteries. The only exceptions are cases when the pulmonary arteries receive mechanical damage.

Hemoptysis in lung cancer develops against the background of malignant transformation of the epithelium of the respiratory tract.Blood loss is usually minimal. Massive bleeding develops only when the tumor grows into a large artery. It is a dangerous condition that can lead to death as a result of asphyxiation or profuse blood loss.

Diagnostic methods in Medskan

Diagnosis for hemoptysis includes:

• History taking – it is important to establish a history of the symptom and the presence of chronic conditions that may have caused it.
• Physical examination – detects accompanying symptoms.
• Laboratory tests – Abnormalities in blood and urine readings may be of clinical significance.
• Computed tomography – in Medscan, CT allows you to identify inflammatory processes, pulmonary neoplasms, to establish their nature, stage of development and the presence of metastases.
• Bronchoscopy – the method makes it possible to assess the condition of the bronchi and take a sample of lung tissue for histological examination.On its basis, the doctor judges the presence of a tumor, its benignity or malignancy.

Methods of treatment in Medskan

The choice of treatment methods depends on the disease that caused the hemoptysis and the stage of its development. In case of malignant neoplasms in the lungs, the following are prescribed:

• early resection;
• chemotherapy;
• radiation therapy;
• immunotherapy;
• targeted therapy;
• stereotactic radiotherapy.

In case of massive bleeding, Medskan specialists carry out embolization of the bronchial artery. This is a minimally invasive method of blocking a bleeding vessel. It allows you to stop blood loss in 90% of cases. If there is no effect, an emergency operation is performed.

90,000 Causes of development and features of manifestation of pulmonary thromboembolism. How is treatment

Causes, symptoms and treatment of pulmonary embolism

Thromboembolism is a pathological condition that develops as a result of blockage of the vessel lumen by a detached blood clot (thrombus).If this happened in the lungs, then the blood simply stops flowing into a separate part of the pulmonary artery, which subsequently leads to the death of this area. Treatment of pulmonary embolism consists in the use of modern techniques, but before choosing a specific tactic, the patient has to go through a diagnostic stage.

Causes and symptoms of pulmonary thromboembolism

The only cause of this condition is the presence of a blood clot (thrombus) in a particular artery.And the following factors can provoke the formation of a clot:

• high and rapid blood coagulation;
• limited mobility – for example, in people undergoing long-term rehabilitation after injury or surgery;
• hereditary diseases characterized by increased blood clotting;
• sepsis.

The causes of vascular thromboembolism can also lie in very simple things – for example, in uncontrolled use of drugs (everyone’s favorite self-medication), improper diet, high blood cholesterol levels, and a sedentary lifestyle.Often, the pathological condition under consideration can be triggered by an already existing oncological disease or a course of chemotherapy.

The signs of the condition in question are characterized as pronounced and exactly correspond to the symptoms of heart / pulmonary failure. They rarely appear all at the same time, but even the presence of one of them is a reason for urgently seeking qualified medical help. Pulmonary thromboembolism symptoms:

• breathing becomes shallow and rapid, shortness of breath progresses;
• when coughing and taking a deep breath, there are complaints of acute pain in the anatomical location of the heart;
• the patient is very weak, he may have dizziness, often there is a loss of consciousness;
• palpitations increase rapidly and persistent tachycardia develops;
• the cervical veins swell and pulsate actively.

As the disease in question progresses, the patient develops a dry cough, then it quickly becomes wet and when sputum is passed, the presence of blood is noted in it. The body temperature may rise, but this is an optional symptom.

Please note: if the blockage with blood clots only touched the lumen of the small pulmonary arteries, then all of the above symptoms will be mild.

How pulmonary thromboembolism is diagnosed

Before starting treatment, the doctor will definitely conduct a full examination of the patient with characteristic complaints.If the patient’s condition does not require emergency medical care, then the diagnosis of pulmonary embolism involves:

• ultrasound lung scanning;
• chest x-ray;
• electrocardiograms;
• blood sampling for laboratory research;
• angiopulmonography.

If the patient’s condition is severe, then he is shown emergency care for pulmonary embolism, which consists in reducing the intensity of symptoms, facilitating breathing and normalizing / stabilizing the heart.Such events are carried out either in the ambulance carriage, or in the intensive care unit of a medical institution.

Treatment of pulmonary artery thromboembolism

Death from pulmonary thromboembolism can occur in the case of a rapidly developing pathological condition, when there is simply no time to provide the patient with qualified medical care. If the patient is in a critical but stable condition, then the chances of successful treatment are quite high. The general principles of treatment include the following:

1. Active oxygen therapy.In some cases, patients are prescribed to be on a ventilator around the clock, through which oxygen is supplied from time to time.
2. Taking medications from the group of anticoagulants. If the blood clots are small and the blockage of the arteries is not yet dangerous, then such treatment is quite enough – blood clotting stabilizes, small blood clots dissolve on their own, new ones are not formed.
3. Therapy with thrombolytic drugs is indicated only in case of severe course of pulmonary embolism.

Often the patient’s condition is so critical that therapeutic methods alone will not be able to help him. In this case, doctors prescribe a surgical intervention – embolectomy, which involves the surgical removal of a blood clot (thrombus). The prognosis after surgery for thromboembolism is not always favorable – surgical intervention is quite complex and is accompanied by a high risk of complications, therefore, such treatment is rarely used.

Of particular importance is the prevention of pulmonary thromboembolism, which consists in the treatment of diseases that can lead to the formation of blood clots.

For more information about the location of the pulmonary embolism clinic, which doctors are consulting on this issue and what treatment the patient will receive if the diagnosis is confirmed, you can find out on the pages of our website Dobrobut.com.

Related services:
Phlebologist consultation
Venous thromboembolic complications

Spine surgery: is it worth it?

When people hear the word “surgery,” the first thing that comes to mind is the risks and their consequences.Surgery can be a daunting experience for a patient, but thanks to modern technology and modern techniques, the risks and complications are far fewer than they were many years ago. Spinal surgery, or back surgery, also has its own risks and complications. The main and most important risk is the risk of paralysis, since the operation is performed very close to the nerves of the spine.
Back surgery also benefits patients. For example, the patient can move freely without pain, becomes physically healthy, mood changes and he or she is no longer in pain, and pain relievers can be reduced or, in some cases, stopped.However, there are still complications.

Complications of spine surgery
If any complications arise during spinal surgery, it is very serious because the surgery is performed close to the spine and spinal cord. Some of the complications may be the need for additional surgery, which is not so beneficial for the patient. The patient has to bear pain, and this is considered a kind of financial loss. Not all patients can afford to have a second operation after the first.Complications should be discussed with the appropriate physician prior to surgery so that the patient can prepare mentally and physically as well as financially.
Complications such as bleeding occur, which means bleeding and the patient is losing a lot of blood. DVT, or more commonly known as blood clots, is another form of complication. It should be added that in some situations the risk of complications increases during surgery, such as: heart disease, hypertension, high blood pressure, stroke, bleeding disorders, obesity, smoking, alcohol and drug abuse, and diabetes.
Another type of complication is the complication of spinal surgery. This surgery aims to improve symptoms such as persistent pain and numbness in the legs that are caused by pressure in the nerves.
Complications of lumber surgery
Complications of lumber surgery are as follows:

Facial wounds and loss of vision: during decompression of lumber, the patient’s face is placed down. The patient rests on the forehead and chin during the operation. In some cases, it has been noticed that a red wound appears on the forehead, but there is nothing to worry about as it may disappear after a few days.
Nerve Injury and Paralysis: Paralysis is not common, but very serious. Nerve damage and paralysis can be caused by bleeding inside the spinal column, leakage of cerebrospinal fluid, accidental nerve damage during surgery, and accidental damage to blood vessels.
Death: The risk of death is present in all operations, but very rarely during and after a lumber operation. A small blood clot, even a reaction to anesthetic and blood loss are life-threatening factors.
In addition to all these complications that arise during the operation, there are several more, such as:
Risk of anesthesia (complication). The most common type of anesthesia is general anesthesia, which makes the patient sleepy during surgery. Special machines make breathing for the patient. In the case of spinal surgery, there is a need for general anesthesia. Studies show that very few patients showed a response to general anesthesia, and complications were with patients who had health problems.To be safe, it is best to explain and tell your doctor about every problem and concern you have. In this way, the doctor will know if the patient is suitable for surgery and anesthesia and the likelihood of complications.
Thrombophlebitis (blood clots): Thrombophlebitis, more commonly known as a blood clot, occurs in the veins of the legs. This complication is very common in various types of surgical procedures. When thrombophlebitis occurs in the veins of the legs, it is called deep vein thrombosis. The risk of DVT is higher with pelvic and lower limb surgeries.

Is there anything to worry about about a blood clot? Yes, when a blood clot fills the veins, they stop the normal flow of blood from the legs directly to the person’s heart. This leads to swelling and pain in the affected leg. It is more dangerous if the blood clot does not dissolve, the pain increases, and the swelling becomes chronic.
Lung Problems: The success of the operation is only visible if it is taken care of after the operation. The lungs are like a sponge, and the small pockets from which blood gets oxygen are like holes in a sponge.After the operation, the patient must take several steps so that the lungs work perfectly. The nurse will advise the patient to take frequent deep breaths and cough frequently. Getting out of bed is an example of patients allowing their lungs to work better. Optimal lung function can be maintained with a respiratory therapist.
Infection: Infections occur in all types of surgery, but occur in less than 1% of spine surgeries. The infection can be in the outer layer of the skin, which is called the superficial, or it can go much deeper through the incisions.Compared to deeper infections, superficial infections are easier to heal.
To prevent infection, the incision area is well cleaned and the patient is given antibiotics before surgery, especially when bone grafting, metal screws and plates are used during surgery. If the surgical wound is hot, red, and swollen and does not heal, it is most likely infected. After all these symptoms, fever, pain, and the wound may ooze a yellow or thin fluid known as pus.In the worst case, the surgeon decides to remove metals and plates from the patient’s body.

Bleeding. Bleeding such as hemophilia, which increases the risk of bleeding before, during and after surgery, is also one of the main and dangerous complications that occur during this surgery.
Sexual dysfunction. Injuries to the human spinal cord and the area surrounding the spinal cord can cause many problems. The patient may not feel sensation, and the nerves in the spinal cord may not transmit signals that allow the rest of the body to function.If even one nerve in the spinal cord that connects to the pelvic area is damaged, sexual dysfunction will result.
Persistent Pain: Some spine surgeries do not relieve the patient’s pain, and a common complication after spinal surgery is that not all surgeries are successful. In some cases, patients complained of pain, even greater than what they had before the operation. Some pain after surgery is excluded, normal and common. However, if the pain is getting worse and if the patient is experiencing chronic pain, the doctor should be informed as soon as possible.
Dural tear: An accidental dural tear during spinal surgery can have many consequences. Incidents vary depending on the severity of the situation and the gap. Cerebrospinal fluid leakage with ruptured dura mater can be a serious medical condition for the patient and can cause problems such as cerebrospinal fluid formation, meningitis, and epidural abscess.

Which method is less risky?
A survey of 122 patients who underwent surgery on lumber shows less blood loss, fewer complications, significantly less blood transferred, patient hospitalization, surgery time and the need for further surgery.Hence, lumber surgery is less risky compared to spine surgery and can be performed without any fear and complications.

A detailed study of spinal surgery and its associated risks is available on the Monib Health website. For more information, feel free to check them out.

90,000 Denmark has suspended the use of the Oxford COVID-19 vaccine

Denmark has suspended vaccinations with the vaccine developed by AstraZeneca and the University of Oxford, the country’s health and drug administration said in a statement (in Danish).

The decision was made due to several reports of blood clots in those vaccinated with this vaccine. One such message concerns a death in Denmark, the release says. So far, the authorities cannot say for sure whether there is a connection between the vaccine and the formation of blood clots, follows from the message. Vaccinations were suspended for 14 days, then the situation will be assessed again. During the pause, even those who have already received the first dose of the vaccine will not be able to receive the second. People may have to queue up later in the spring or even early summer, warned Seren Brostrom, director of Denmark’s national health council.

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The statement of the department does not say how many cases of blood clots and where exactly were recorded. Austria suspended vaccinations with AstraZeneca last week after the death of one vaccinated patient and serious illness of another. A 49-year-old woman died of a serious bleeding disorder, while another developed pulmonary embolism and was recovering, the Federal Office of Healthcare Safety said.Thromboembolism is a pulmonary disease caused by a blood clot that blocks a main artery, Reuters explained. The Austrian authorities also noted that there is no direct association of these cases with vaccinations, and blood clots are not among the typical side effects for the AstraZeneca and Oxford vaccines.

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The European Medicines Agency (EMA) announced on March 10 that it had begun screening cases in Austria, but nothing indicated at the time of publication of the release that vaccination led to health problems and death.The EMA added that several other countries have suspended the vaccine – Estonia, Latvia, Lithuania and Luxembourg.

Shares of AstraZeneca were reduced by 2.43% on the London Stock Exchange (as of 15:00 Moscow time). The company said the safety of its vaccine was seriously tested during the third phase of trials and reviewer reports confirm that the vaccine is, on average, well tolerated, Bloomberg was quoted as saying.

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The effectiveness of the vaccine from AstraZeneca and Oxford against coronavirus was 63.09%, and its effectiveness increases with the lengthening of the interval between two doses in period boundaries from eight to 12 weeks, the World Health Organization reported.

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