Thursday, March 26, 2015
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

New medications prevent harmful blood clots

By
From page B10 | January 26, 2013 |

Among the fifteen million patients discharged from hospitals in the United States annually, an estimated 51 percent are at risk of developing blood clots, called “thromboses,” or of spread of these clots to vital organs, which we call “embolism.”

Prevention of blood clots is an important issue. We are particularly concerned about this problem in persons with underlying medical problems that predispose to poor circulation, such as swelling of the legs, diabetes, or chronically irregular heart beats.

Typically, we prescribe blood thinners in the wake of a catastrophic event involving a blood clot. Examples include a blood clot in the legs. This may occur out of the blue, as an “idiopathic” or unexplained phenomenon.

Other causes may include the use of birth control pills, prolonged immobility on a long airplane flight, or impaired circulation due to prior injuries to the legs. There are also less common conditions that predispose an individual to blood clot formation, including inherited deficiencies or mutations in blood coagulation proteins.

Hematologists are experts at sorting out these conditions, as internal medicine specialists with expertise in diagnosing and treating blood disorders. Systemic lupus erthematosus, an auto-immune disease within my own field of rheumatology, can cause the blood to be excessively prone to clotting. When you think of it, the blood is a marvelous body tissue, capable of clotting when we have an accident and get cut, but also capable of coursing unimpeded through our arteries and veins from day-to-day. It is no wonder that this marvelous balance is occasionally perturbed. In fact, it is amazing that our blood works as well as it does, most of the time.

The most feared complication of a lower extremity blood clot is the possibility of an embolus, or broken off clot, passing through the blood to the heart, brain or lungs. The latter condition, called a “pulmonary embolism,” is potentially life-threatening and often difficult to diagnose, causing the sudden onset of shortness of breath, chest pain, and even sudden death. Severe blood clots may necessitate life-long blood-thinning, or “anti-coagulation” therapy. Traditionally, this involved two medications, heparin and coumadin. Heparin has a rapid effect, and used to be given intravenously in hospitals.

About thirty years ago, researchers developed a more convenient type of heparin, called “low molecular weight,” which is injectable under the skin. As heparin thins the blood acutely, a longer acting medication taken orally, called coumadin, is typically prescribed. The problem with coumadin, however, is that patients on this medication require constant rechecking of blood tests, and constant adjustment of the medication. For example, dietary intake of high levels of vegetables can lower the effect of the medication, necessitating a higher dose. Conversely, some medications can alter metabolism of the drug, necessitating that coumadin doses be lowered. I once ran a clinic entirely devoted to adjusting coumadin levels on patients in a large institutional setting. That is how cumbersome coumadin therapy may be. New drugs, however, are on the horizon, if not already available.

Pradaxa (dabigatran etexilate) and Xarelto (rivaroxaban) are approved alternatives to coumadin. Last month, the Food and Drug Administration also announced approval of Eliquis (apixaban) as another anticlotting drug. Pharmaceutical manufacturers are jockeying to develop newer agents that offer greater ease of administration, with comparable efficacy to older agents.

Elderly patients with irregular heart rhythms, such as “atrial fibrillation,” represent a common therapeutic challenge. An irregular heart rhythm may lead to blood clot formation, with the potential for a secondary stroke developing. Staying active and well hydrated is a good idea for most patients. Contracting leg muscles, for example, improves circulation to and from the legs. For specific recommendations, see your physician.

Scott Anderson, M.D., Ph.D. ([email protected]) is Clinical Professor of Medicine, Division of Rheumatology, UC Davis. This column is informational, and does not constitute medical advice.

Scott Anderson

LEAVE A COMMENT

Discussion | 1 comment

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

  • CD BrooksApril 30, 2013 - 6:59 am

    Abigail, they are both very much like Conservatives. For example, Boehner would be an aneurysm where he sneaks in with very little evidence, inflates, gets weak and explodes, so without immediate care you bleed out. McConnell would be the blood clot where he rolls around through your veins and if allowed to continue, goes to your heart or brain and kills you. But no worries, the “physicians” among you will replace the threats in 2014. Okay?

    Reply | Report abusive comment
.

Solano News

Vacaville honors top cops, support staff

By Kevin W. Green | From Page: A1, 2 Comments | Gallery

 
 
Kings honor Rankin, Mustangs

By Paul Farmer | From Page: A2, 1 Comment | Gallery

 
Fairfield mall to host first aid kit assembly party

By Susan Hiland | From Page: A3

Fairfield PD chief to address Solano GOP

By Susan Hiland | From Page: A3, 1 Comment

 
New meeting location for family support group

By Kevin W. Green | From Page: A3

 
Padan Elementary demonstrates new school culture

By Susan Hiland | From Page: A3, 2 Comments | Gallery

 
 
Suisun City police log: March 24, 2015

By Susan Hiland | From Page: A7

Frustration permeates college contract negotiations

By Susan Winlow | From Page: A7 | Gallery

 
Fairfield police log: March 24, 2015

By Susan Hiland | From Page: A7

.

US / World

Vallejo woman’s story a hoax, police say

By The Associated Press | From Page: A1, 5 Comments

 
Deceased woman’s video supports Wolk’s bill

By The Associated Press | From Page: A4

 
Man threatened suicide before shooting officer

By The Associated Press | From Page: A6

.

Opinion

 
We deserve freedom to choose our fate

By Kelvin Wade | From Page: A5, 4 Comments

 
.

Living

Community Calendar: March 26, 2015

By Susan Hiland | From Page: A2

 
Today in History: March 26, 2015

By The Associated Press | From Page: A2

Horoscopes: March 26, 2015

By Holiday Mathis | From Page: A9

 
After several years, my nieces now live with their father and are miserable

By Kathy Mitchell and Marcy Sugar | From Page: A9

.

Entertainment

Contract not renewed for ‘Top Gear’ host

By The Associated Press | From Page: B5

 
TVGrid

By Daily Republic Syndicated Content | From Page: B5

Felicity Jones excited, tight-lipped about Star Wars role

By The Associated Press | From Page: B5

 
David Crosby in car accident with jogger

By The Associated Press | From Page: B5

.

Sports

 
Prep badminton preview: City teams making their marks

By Brian Arnold | From Page: B1, 1 Comment | Gallery

6 teams with 10 or more losses most ever to reach Sweet 16

By The Associated Press | From Page: B1

 
After 1st division title in 39 years, Warriors want more

By The Associated Press | From Page: B1

Local report: Rodriguez boys swim past Vintage

By Daily Republic staff | From Page: B1

 
Bills to honor late owner Wilson with life-sized statue

By The Associated Press | From Page: B2

Tulowitzki homers, Butler strong in Rockies’ win over Giants

By The Associated Press | From Page: B2

 
Elliott heads to Martinsville to attempt 1st Sprint Cup race

By The Associated Press | From Page: B2

Alameda County to join talks about new Oakland stadium

By The Associated Press | From Page: B2

 
Rio mayor unveils controversial Olympic golf course

By The Associated Press | From Page: B2

Joe Gibbs’ son being treated for ‘brain function’ issues

By The Associated Press | From Page: B2

 
America’s Cup organizers want smaller, cheaper boats

By The Associated Press | From Page: B2

Gomez uses offense and defense, leads Brewers past A’s

By The Associated Press | From Page: B2

 
Cal to host UC Davis in 2019, Cal Poly in 2020

By The Associated Press | From Page: B2

Lanny McDonald selected as chairman of Hockey Hall of Fame

By The Associated Press | From Page: B2

 
Serena Williams hoping to play at Miami Open

By The Associated Press | From Page: B2

Change to extra points likely in NFL

By The Associated Press | From Page: B2

 
.

Business

.

Obituaries

Howard Leon Carnes

By Nancy Green | From Page: A4

 
.

Comics

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

Dilbert

By Daily Republic Syndicated Content | From Page: A8

 
Peanuts

By Daily Republic Syndicated Content | From Page: A8

Blondie

By Daily Republic Syndicated Content | From Page: A8

 
Garfield

By Daily Republic Syndicated Content | From Page: A8

Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

 
Pickles

By Daily Republic Syndicated Content | From Page: A8

Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

 
Baldo

By Daily Republic Syndicated Content | From Page: A8

Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

 
Sally Forth

By Daily Republic Syndicated Content | From Page: A8

B.C.

By Daily Republic Syndicated Content | From Page: A8

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Zits

By Daily Republic Syndicated Content | From Page: A8

Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

 
Bridge

By Daily Republic Syndicated Content | From Page: A9

Sudoku

By Daily Republic Syndicated Content | From Page: A9

 
Crossword

By Daily Republic Syndicated Content | From Page: A9

Cryptoquote

By Daily Republic Syndicated Content | From Page: A9