Tag: Blood Clot Doctors

BLOOD THINNING MEDICATIONS PART 1: ANTICOAGULANTS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Over the next few weeks, I want to discuss the medications that vascular surgeons may prescribe.  These medications include anticoagulants, antiplatelets, statins, and other miscellaneous agents.  This week I will discuss anticoagulants!

Anticoagulation refers to agents that STOP the clotting of blood.  The clotting of blood starts with what is known as the coagulation cascade.  The cascade refers to a series of consecutive events each involving special proteins that are needed to occur for blood to form a clot.  Different anticoagulants block specific parts of the cascade.  The main reason we usually see patients with anticoagulants are for hypercoagulable states, certain heart arrhythmias like atrial fibrillation, and deep vein thromboses otherwise known as blood clots.  Hypercoagulable states are specific genetically inherited disorders that result in the blood being more likely to clot.  Atrial fibrillation and other arrhythmias can cause blood clots to form in the heart.

 

Anticoagulant agents are given to prevent the formation of clots in the heart that can then break off and go to the brain, hands, feet, kidneys, or any other part of the body and cause problems. 

 

Deep vein thrombosis or blood clots mandate the prescription of anticoagulant therapy to ensure that more blood clot does not form.

 

Anticoagulants can be broken up by many different classification schemes.  For the purposes of this blog, I will limit our discussion here to agents that are appropriate for the OUTPATIENT (Outside of the hospital) setting.  Please speak with you private physician to answer any additional questions you may have regarding Anticoagulation medication of feel free to reach out to me directions for more information on how anticoagulation is used. Anticoagulation agents that are used during hospitalization or in the IN-PATIENT setting in patients are outside the scope of this article.

 

Up until the 2010’s the mainstay of anticoagulation therapy was with a drug called warfarin (Trade name: Coumadin).  Warfarin, though effective, requires the weekly or biweekly measurement of a specific lab for the blood called the prothrombin time.  The active monitoring of the prothrombin time facilitates modulation of dosing to always allow for safe levels of effective therapeutic anticoagulation.  Since the beginning of the 21st century new agents have come to market that require only taking one or two pills a day.  They include Xarelto or Rivaroxaban and Eliquis or apixaban.

If you have a question about how your medications may be affecting your vascular disease, please do not hesitate to call and schedule an appointment today!

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

WHEN HIP PAIN MAY BE MORE THAN JUST ARTHRITIS

Posted on by Angelica Rodezno

Do your legs hurt when you walk? Can you only walk a block or two before you start experiencing cramping in your hip or buttock? Often times, patients are told this is just a normal part of getting older and probably due to arthritis. But sometimes it isn’t. If your pain only happens when you walk a certain distance and stops when you stop walking, it may be a circulation issue known as claudication. Claudication is a vascular condition that occurs when your leg muscles do not get enough blood flow while they are being used. This is generally caused by a build-up of plaque in the arteries–known as atherosclerosis–in your abdomen or legs. This build-up of plaque on the inside of the arteries, which carry oxygen and nutrients to your organs and muscles, restricts how much blood and therefore oxygen can get to the muscles. When you walk, you use energy, and your muscle requires more oxygen and nutrients to work. If the muscle does not get this needed oxygen, it begins to cramp up. This causes pain, and ultimately causes you to stop walking. Those at risk for this happening are people over the age of 60, those who smoke or were smokers in the past, those with high cholesterol or high blood pressure, and those who have heart disease or have had an ischemic stroke.

This problem can occur in one or multiple arteries from your belly button to your knee. It can be easily diagnosed on exam by simply feeling pulses in the patient’s groin, behind their knees, and at their ankles to check for blood flow. We can also listen for an abnormal sound called a “bruit” in the abdomen or the groin with a stethoscope. Where the pain is in your leg gives a clue as to where the problem is in your arteries. If there is a problem in the arteries in your abdomen or pelvis (the aorta and iliac arteries), it will cause buttock or hip pain with walking. This is often confused as hip arthritis or bursitis by medical doctors and patients. At SBVC, we have seen many patients who have had multiple injections into their backs or hip joints with no relief. On exam, we find they do not have pulses in their groin. An ultrasound done by specialized vascular technologists checking blood flow in the arteries will confirm this exam finding and can help plan treatment. Most treatments today are directed at opening the blood vessels up with surgery or a stent procedure. These are very safe and can immediately provide relief from pain and allow the patient to walk much longer distances than before. If you believe you are suffering from claudication, please talk to your doctor about your options. You may benefit from seeing a vascular surgeon for ultrasound and possible treatment.

BLOOD CLOTS AND AIRLINE TRAVEL

Posted on by Angelica Rodezno

People are more mobile today….everyday traveling to more and more places by plane, train, and automobile. Now, more than ever, vast numbers of business people and pleasure seekers cross the globe on a daily basis for work, opportunity and adventure.

As difficult (and as exciting as travel can be) extended periods of immobility during these long trips carries a hidden risk…a sometime fatal risk…especially if one is squished into the middle seat in the back of the plane for hours on end making it difficult to get up and move: the risk of developing a DVT (more commonly known as a blood clot) in the deep veins of their legs.

Veins are a network of blood vessels that work to return blood TO the heart (as compared to arteries which are blood vessels that transfer blood AWAY from the heart) Veins work by using a series of very small valves to keep blood flowing in a single direction and, generally, prevent blood from going back towards the ground even though gravity exerts a constant force to pull the blood down.

One’s calf muscles play a critical role in the venous system. These muscles, when activated, act like a “pump” to help squeeze blood back up through the veins and back up to their heart. When immobile,especially common during long periods of travel, the muscles cannot help the veins do their job, and the blood just sits in your legs. Blood naturally has proteins in it that helps it clot so that you don’t bleed to death after a cut or injury. When these clots develop, the leg can become swollen and painful. Many people develop leg swelling during long plane or car travel. However, one big differentiating factor between that kind of swelling and a DVT is that a DVT usually only happens on one leg. Often, the swelling persists for more than a little while after you get moving again. In addition, the leg, especially in the area of the calf muscle, is often tender when squeezed.

In the event that you experience the kind of symptoms explained above it is vitally important to go to the doctor or emergency room immediately. The most feared complication of a DVT is when the clot in the leg travels to the lung causing a PE—a pulmonary embolus. This can cause shortness of breath, chest pain, and even death. In fact, PE is the third most common cause of death in the United States, and few regular people know about it. If you do think you have a blood clot, it is important to get an ultrasound to diagnose it and to be started on blood thinners. It is also very important to see a doctor who specializes in blood clots, often a vascular surgeon, to evaluate whether or not there is another reason in addition to travel that this may have happened. Occasionally, having a DVT is a sign of a more serious underlying issue, and the travel just precipitated its occurrence.

At SBVC, our physicians and surgeons aggressively work up patients who present with the symptoms of a DVT to make sure there is no other contributing factor. We work closely with your primary care doctor, and occasionally call in hematologists (specialists in blood problems) to consult as well. If you or anyone you know suffers from non resolving swollen calf’s or legs following a long flight please call our office at 408-376-3626 to schedule an immediate visit to determine the extent of and appropriate treatment for DVT.

To learn more about blood clots and flying click on the attached link to visit a more detailed article on healthline.com

https://www.healthline.com/health/dvt-and-flying