lots of clots
Helderberg Cardiac
Support Group Seminar
Dr Tom Mabin
Vergelegen Mediclinic
Somerset West
October 16th 2015
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.
The penalties………
• Coronary artery = myocardial infarction (heart attack)
• Brain artery = stroke
• Leg vein
• Left atrium
lungs = pulmonary embolus
brain = stroke
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
+
=
Red blood cells
Anti-platelets
Aspirin
clopidogrel
Clot (thrombus)
Antithrombotics
heparin
Thrombolytics
“clot busters”
IV drugs
The sequence of clot formation in the arteries and where the drugs work
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
Stents can play a vital role in busting up the clot and
ifig clearing the plaque. Again, time is
factor
need to be inhibitedthe using
aspirin and clopidogrel
Direction of blood flow….
Arteries flow
away from the
heart: rapid flow high
pressure
Veins flow back
to the heart: slow
flow and sluggish
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
Pradaxa
• Single daily dose
• Rash
• bleeding
• 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:
ASPIRIN
CLOPIDOGREL(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 with
WARFARIN
XARELTO
PRADAXA
Different strokes for different folks…who takes
what?
Aspirin or clopidogrel
• Angina
• Heart attack
• Stent
• Bypass
• Stroke
• TIA
any arterial disease
Warfarin or NOAC
• Atrial fibrillation
• DVT
• Pulmonary embolus
Different strokes for different folks…who takes
what?
Thankyou………