Blood Clots
All bleeding eventually stops when the blood forms a clot, or all the blood drains out of the body. Our goal is the first choice, not the second. Everybody can make a clot. There are good clots and bad clots. Good clots stop bleeding when we cut or bruise ourselves. Bad clots are the ones that form in vessels and block the vessel. This we do not need. These clots occur in certain veins because the blood flow is so sluggish that it grinds to a halt and coagulates. This can occur in large veins, particularly in the legs, of patients:
- who are immobile, or
- whose veins have been injured, or
- just tend to like to form clots.
Sometimes these clots break off and head north, passing through the heart, into the lungs and getting stuck there. This is called a pulmonary embolus. Embolus is a traveling clot. Why do they go directly to the lungs? That is just the way the plumbing is laid out and there really is nowhere else to go in most cases.
What do we do about clots?
We dissolve them and prevent them from growing bigger. The drugs to stop coagulation are anticoagulants (a logical name). To rapidly dissolve a clot we can give very powerful drugs such as TPA, Streptokinase, or Urokinase in the hospital. The major side effect is bleeding, and often the risk far outweighs the benefit. The most commonly employed drug that can help dissolve the clot is heparin. It is given continuously intravenously for about 7 days. Simultaneously it necessary to start long term therapy with anticoagulation that can be taken as an outpatient. Usually we use Coumadin. Coumadin works by blocking vitamin K from making clotting factors (chemicals that form clots) in the liver . As with all anticoagulation medicine, the major side effect is bleeding. Consequently it is necessary to check a blood test quite frequently to be certain that the Coumadin is in the proper therapeutic range. The blood test is called the Prothrombin Time or PT. Coumadin therapy is continued for anywhere from 3 months to a lifetime, depending on risk factors, diagnosis, and clinical course.
Instructions
It is therefore necessary to follow these directions precisely when taking Coumadin in order to obtain the maximal benefit and avoid complications.
- Keep close track of the Coumadin dose. Slight variations can have devastating effects.
- Avoid foods high in vitamin K, such as broccoli, beef liver, cabbage, cauliflower, chicken liver, turnip greens, chick peas, lentils, pork liver, seaweed, soybean oil, spinach, green tea.
- Avoid vitamins that contain vitamin K.
- Do not drink alcohol.
- Do not drink herbal teas containing coumarin.
- Notify the doctor if you are taking antibiotics. The Coumadin dose may need to be adjusted.
- Do not have surgery unless plans are made to stop Coumadin ahead of time.
- Have the PT checked regularly.
