Friday Q&A: All About Blood Clots🩸
It's World Thrombosis Day!
ICYMI 👉
I recently saw a healthy patient in her 40s for pain and swelling of her left foot.
Six weeks prior, she had banged up her left leg after falling on a hiking trail. She got stitches at an urgent care and a brace for her knee. During that time she took a plane ride across the country. The icing on the cake? She recently resumed taking the birth control pill.
So, neither of us was surprised when, later that day, a sonogram revealed a DVT (deep vein thrombosis) in her calf. Why? She had checked all three boxes of Vichow’s Triad.
Virchow’s Triad is a concept that describes the three major factors contributing to the formation of blood clots or thrombosis in blood vessels. They are:
Stasis of Blood Flow: When blood flows too slowly or becomes stagnant within a blood vessel, it increases the risk of clot formation. This can occur in situations where there is reduced movement of blood, such as during prolonged immobility or in areas of a blood vessel with abnormal flow patterns. (Think: long plane ride.)
Endothelial Injury: The endothelium is the inner lining of blood vessels. When the endothelium is damaged from factors like trauma or infection, it can provide a surface for blood platelets and clotting factors to adhere to, initiating the formation of a blood clot. (Think: cuts on a hiking trail.)
Hypercoagulability: This refers to a state in which the blood has an increased tendency to clot. This can be caused by various factors, including genetic conditions, certain medications, and underlying medical issues that affect the balance of procoagulant (promoting clotting) and anticoagulant (inhibiting clotting) factors in the blood. (Think: birth control pills.)
Virchow's Triad helped me explain to my patient how “the perfect storm” erupted in her leg, and the reasoning behind starting her on blood-thinning medications right away.
In honor of my patient—and of World Thrombosis Day (today!)—I'm answering some FAQs about blood clots.🩸
Question #1 is free for everyone. Questions #2-4 are for paid subscribers only.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
QUESTION #1
What is Thrombosis?
When a blood clot forms within a blood vessel, the condition is called “thrombosis.” The clot itself is a “thrombus.” Thrombus formation can happen in both veins and arteries. A clot that forms within a vein is referred to as venous thrombosis, while a clot in an artery is termed arterial thrombosis.
Once a venous thrombus takes shape, it has the potential to impede or obstruct the regular flow of blood and can even detach and travel throughout the body via the circulatory system. When a clot migrates within the bloodstream, it's known as an embolism. It's essential to recognize that thrombosis often serves as the underlying pathology for conditions like heart attacks, thromboembolic strokes, and venous thromboembolism (VTE), which are the three leading causes of cardiovascular-related mortality.
Both types of thrombosis (venous and arterial) can be influenced by various risk factors, which may be either acquired or inherited, although the specific risk factors can vary between the two.
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QUESTION #2
Who is at risk for developing thrombosis?
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