lots of clots

Dr Tom Mabin

Vergelegen Mediclinic

Somerset West

October 16th 2015

Helderberg Cardiac Support Group Seminar

The players………..

Red blood cells

Kick-off……….what starts it all off?

any breach of the artery wall

The scrum……………………..

The sequence of clot formation

Red blood cells

+

=

Clot (thrombus)

The perfect try…………..

Foul play….clots however can form in unwanted area within the blood vessels of the body.

• Coronary artery = myocardial infarction (heart attack)

• Brain artery = stroke

• Leg vein lungs = pulmonary embolus

• Left atrium brain = stroke

The penalties………

Blood flow in a normal artery…….good clean play

This lining of the artery can however become diseased with build up of plaque and becomes abrasive………

Plaque contents may rupture into the mainstream of the artery and this activates platelets and clot formation in exactly the same way……………..

Yellow card

Myocardial infarction(heart attack)……

Red card

Stroke….also a red card

Red card

Various drugs are used to *prevent the formation of clots *to remove clots

*do both

The sequence of clot formation in the arteries and where the drugs work

Red blood cells

+

=

Clot (thrombus)

Anti-plateletsAspirin

clopidogrel

Antithromboticsheparin

Thrombolytics“clot busters”

IV drugs

Once the clot is formed it needs to be broken up by the “clot busters”

These are given in a drip and the sooner they are given, the more likely to be effective.Best <2 hours after onset

of heart attck (<4 hours for stroke)

However stents can also attract platelets and they need to be inhibited using aspirin and clopidogrelifigStents can play a vital role in busting up the clot and clearing the plaque. Again, time is

the factor

Direction of blood flow….

Veins flow back to the heart: slow flow and sluggish

Arteries flow

away from the heart: rapid flow high

pressure

Risk factors are:-• Varicose veins• After surgery• After long air flights

Pulmonary embolus

Another common area of slow flow and clot formation is in the left atrium of the heart after atrial fibrillation has developed

Stroke: atrial fibrillation is the commonest cause

Anticoagulation is required

Full ANTICOAGULATION is required when fully formed clots are at risk of detaching and travelling to critical areas eg lungs and brain

WARFARIN:

• Effective• Cheap• Safe under instruction• Atrial fibrillation• DVT• Artificial heart valves• Reversible

• Requires regular blood tests INR• Interacts with various

medications eg antibiotics;pain pills• Bleeding risk

New Anticoagulants: NOACs:

• More effective than warfarin• Regular daily dose• No blood testing• No interactions with medications

• Expensive• No antidotes• Bleeding• Ineffective with artificial heart

valves

NOACs currently available

Xarelto• Single daily dose• Rash• bleeding

Pradaxa• Twice a day• Care with kidney function• Indigestion• bleeding

Left atrial appendage plug for those who cannot/will not take an anticoagulant

Drugs used to manage clots in the body vary according to when and where and what the problems are…

• To prevent clot formation we make the platelets less “sticky”

using:ASPIRINCLOPIDOGREL(Plavix)HEPARIN(Clexane)

• Once the clot has formed we need to dissolve it using the clot busters:

THROMBOLYTICS

.to avoid dislodge of clot in veins and the heart we need ANTICOAGULATION withWARFARINXARELTOPRADAXA

Different strokes for different folks…who takes what?Aspirin or clopidogrel• Angina• Heart attack• Stent• Bypass• Stroke• TIAany arterial disease

Warfarin or NOAC• Atrial fibrillation• DVT• Pulmonary embolus

Different strokes for different folks…who takes what?

Thankyou………