What Is Thrombosis?
The formation of blood clots inside the blood vessels, such as veins or, in some cases, arteries, is called thrombosis. The clots can be formed in the veins all over the body, including the veins of the arms. It is a severe condition that follows a surgical procedure, can occur as a side effect of a medication, or can be a complication of a chronic disease. If thrombosis occurs in the veins, it is called venous thrombosis; when it appears in the arteries, it is called arterial thrombosis.
What Is Thrombophilia?
The tendency of a person to develop a blood clot is called thrombophilia, and it is of two types: inherited and acquired.
How Is Thrombophilia Classified?
The classification of thrombophilia is described below:
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Inherited Thrombophilia: This type of thrombophilia affects people from birth. These can be due to genetic mutations.
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Acquired Thrombophilia: This type of thrombophilia affects people after birth. These can be due to certain medical conditions, such as trauma, obesity, smoking, lifestyle changes, and oral contraceptive use.
What Is Axillo-subclavian Vein Thrombosis?
When there is the formation of blood clots in the veins of the arms, it is called axilla-subclavian vein thrombosis. The patient may experience less mobility of the arm, pain, swelling, and warmth. If the condition is left untreated, the blood clot may break off and go to the lungs. The symptoms include breathing difficulties and chest pain. The condition may affect the cardiovascular system.
What Are the Acquired Causes of Thrombosis?
The following are the important acquired causes of thrombosis:
Pregnancy: It might be shocking to know, but of all the causes of maternal death in pregnancy, thrombosis is the most common, with an incidence of about five deaths in every 1000 pregnancies.
The formation of a blood clot in pregnancy is attributed to the following causes:
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Reduced blood flow rate, which increases the risk of blood pooling, most commonly in the legs.
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Reduction in the level of natural anticoagulants like protein S (both free and total) and antithrombin. The liver makes protein S, a vitamin-K-dependent protein that combines with activated protein C to bring about a blood-thinning effect. Antithrombin is a natural anticoagulant that halts the formation of blood clots after there is no need for a blood clotting mechanism.
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The level of clotting proteins in the blood, like von Willebrand factor, factor VIII, and fibrinogen, increases.
In pregnant women with a history of deep vein thrombosis or inherited clotting disorders, the risk of developing thrombosis can go as far as 75 percent.
Hormone Therapy- In women who undergo hormone therapy or those taking oral contraceptive pills, the hormone fluctuations appear similar to pregnancy. This leads to changes in clotting protein levels and increases the risk of developing thrombosis. This risk is a bit higher for people with factor V Leiden.
Autoimmune Disorders- Autoimmune disorders like antiphospholipid antibody syndrome are another vital cause of thrombosis. Antibodies are produced against phospholipids like cardiolipin and β2 glycoprotein I. Cardiolipin is needed for respiratory enzyme activity, and β2 glycoprotein I helps regulate coagulation. A rapidly developing antiphospholipid syndrome, called a catastrophic antiphospholipid syndrome, can bring about multiorgan failure.
The antiphospholipid syndrome causes thrombosis by the following mechanisms:
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Decreasing the synthesis of a natural anticoagulant called activated protein C.
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Enhancing the aggregation of platelets to form a platelet plug.
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Stopping the activity of another natural anticoagulant, antithrombin.
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Another autoimmune disorder that brings about thrombosis is lupus anticoagulant. Lupus anticoagulants are produced following a recent infection. However, in children, these are temporary and do not require treatment. Sometimes, it can be permanent or may have a recurrence.
Heparin-Induced Thrombocytopenia- In patients who take heparin, the formation of antibodies against the heparin or platelet factor-4 complex is possible. These antibodies bind with the platelet surface and activate the platelet, which further binds with the blood vessel walls and increases the activity of platelet factor-4. Consequently, raised platelet aggregation and a decrease in the platelet count result in thrombocytopenia. Therefore, despite taking heparin, platelet plug formation and thrombosis are present. This kind of reaction is usually evident in the blood reports after five to seven days of taking heparin. The effects can be seen in one to three days in patients who have already taken heparin or have heparin sensitivity.
The risk of developing such a condition is increased in the following groups of people:
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Hospitalized patients.
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Patients with cardiovascular diseases.
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Individuals who underwent orthopedic surgery.
Cancer: It is associated with an increased risk of thrombosis due to tumor-induced inflammation and compression of blood vessels by the tumor mass.
Infections: Certain infections that can cause sepsis increase the risk of thrombosis. Due to infection, the body's response activates the clotting system.
Obesity: The obese persons are at high risk of getting thrombosis because obesity is associated with chronic inflammation. The rise in pro-coagulant substances contributes to an increased risk of developing thrombosis.
Smoking: Tobacco contains certain chemicals that may damage blood vessels and promote clot formation. This may raise the risk of thrombosis.
What Are The Signs And Symptoms of Thrombosis?
The formation of blood clots varies based on size and location. It may form anywhere in the body, but the common locations are blood clots in the veins of the arms and legs. People with blood clots in the veins of the arms and legs experience the following symptoms:
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Low-grade fever.
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Redness.
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Pain.
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Swelling.
Thrombosis has the following symptoms:
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Leg pain, usually on the inner thighs, and most commonly involves only one leg.
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Numbness or weakness that affects one side of the body.
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Swelling in the extremities.
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Mental disturbance.
Although these are the most commonly encountered symptoms of thrombosis, they can differ from one individual to another.
How Is Thrombosis Diagnosed?
Diagnosing thrombosis involves taking a medical history and doing a complete physical examination of the patient.
In addition, the following tests are done to help in the diagnosis of thrombosis:
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Blood Examination - Blood tests are taken to determine the clotting tendency of an individual.
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Ultrasound - With sound waves' help, blood flow in the arteries and veins is checked.
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Venography - In this test, X-rays are taken after a dye is injected into the veins. It helps in identifying the blood flow and the presence of any clots.
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Imaging Tests - Imaging tests like magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and computerized tomography (CT) scans are done to assess the type and location of the blood clot.
What Is the Treatment for Thrombosis?
Treatment for thrombosis depends on the individual's health condition, the disease's severity, and the associated complications.
The following are the available treatment modalities for thrombosis:
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Medications that prevent blood clot formation, like blood thinners or anticoagulants. The oral anticoagulants are prescribed to prevent blood clot formation. It reduces the risk of thrombosis. Antiplatelet drugs, such as Aspirin, are prescribed to block platelet activity and prevent blood clotting.
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Vasodilation (dilating the narrowed blood vessels) with the help of catheters.
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Placing a stent (vascular stenting) to prevent blood vessels from contracting.
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The immobility management is by leg exercises and compression stockings.
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Lifestyle changes include weight management, regular exercise, smoking cessation, and a healthy diet to improve cardiovascular health.
Conclusion:
Thrombosis is a severe condition that, if left untreated, can bring about life-threatening complications. Acquired causes of thrombosis can be prevented by taking appropriate precautions. At times of pregnancy or while taking birth control pills, take the healthcare provider's advice to avoid thrombosis. Also, an individual should not take or change the dosage of heparin by themselves without consulting with the doctor.
