Thrombosis

Thrombosis. Or thrombus is a mass that forms inside the circulatory system and is made up of the patient’s blood, specifically the solid elements of the blood.

In a living individual, blood can clot but this is outside the circulatory system, for example, blood that passes to the peritoneum, pleura, or pericardium. There the blood coagulates and it is not a thrombus, because it is outside the cardiovascular system.

In easier terms, thrombosis occurs when blood clots (thrombi) block the veins or arteries , hindering or preventing the normal flow of blood.

Summary

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  • 1 Causes
  • 2 Symptoms
    • 1 V Leiden
    • 2 Phlebitis
    • 3 Thrombosis and cancer
    • 4 Fetal loss due to thrombophilia or hypercoagulability
    • 5 Atherosclerosis and thrombosis
    • 6 Thrombosis in history
  • 3 Types of thrombosis
  • 4 Complications
  • 5 Diagnosis
  • 6 Treatment
  • 7 Prevention
  • 8 Sources

Causes

The mechanisms that favor the formation of a thrombus are alterations in blood flow and these alterations may be due to excessive bed rest (postoperative patients). Furthermore, in the surgical intervention there has been a stimulation of the coagulation factors due to the rupture of vessels, the suture, a series of interventions that involve the vascular system.

It is not uncommon for an individual to undergo an inguinal hernia , and the moment he is discharged and begins to move more than he has moved in the previous days, he presents a fulminant embolism causing death.

Other pathologies that can cause a thrombosis are those that present vortex flows, such as valve narrowing. An example is mitral stenosis , where the flow in the atrium slows down and favors thrombosis.

In mitral stenosis, it should be borne in mind that thrombosis is most likely in the appendage and somewhere in the wall of the atrium. And if that flutters or fibrillates , contraction of the atrium is inefficient.

Then the atrium does not contract and there is also occlusion in the outlet, so that there is a slow outflow and therefore formation of clots (thrombi).

Another cause of thrombosis is damage to the endothelium. If a vessel becomes inflamed from trauma, a neighborhood injury and endothelial damage occurs, which immediately triggers the coagulation cascade, depositing thrombi on the surface of the vessel.

As for the foreign liquids that enter the circulatory system and can cause an embolism, these can be fundamentally the amniotic fluid that enters the maternal circulation when detachment of the placenta occurs, and rupture of the uterine and / or cervical veins constituting an amniotic embolism , depending on the amount, it can be fatal.

Also in multiple fractures, the fatty bone marrow of the bones that is semi-liquid can enter the circulation and embolize into the lung or brain.

The third influencing cause is blood components. When blood is denser, fluids decrease and figurative elements increase. Or there is a hemoconcentration or a real polycythemia. This includes repeat thrombosis.

Thrombus formation sites are in the heart , arteries, veins, and capillaries , so thrombosis can form anywhere in the circulatory system .

Symptoms

Depending on the size and location of the thrombus, some of the symptoms may vary:

  • Swelling of the arms or legs or feeling of weight.
  • Pain in the leg or arm with no known cause.
  • Increased temperature in the legs.
  • Difficulty walking or moving the arm.
  • Color changes, tingling in the legs.
  • Feeling of “suffocation”.
  • Faster heart beat, chest or breathing discomfort.
  • Absence of pulse.

V Leiden

The most frequent genetic risk factor for venous thrombosis is factor V Leiden , present in 5 percent of the general population. Factor V is one of the normal blood clotting factors.

Factor V Leiden is a changed or “mutated” form of factor V that inactivates ten times more slowly than normal factor V. This causes it to stay in the circulation longer, producing a state of hypercoagulation. In other words, the blood continues to clot, causing a possible blockage.

One copy of the factor V Leiden gene increases the risk of venous thrombosis 4 to 8 times, while two copies of the gene increase the risk 80 times.

Other coexisting coagulation defects can occur with factor V Leiden and, in general, the risk of thrombosis increases in patients who have more than one genetic defect.

The factor V Leiden mutation is implicated in 20-40 percent of venous thrombosis cases, and is suspected in individuals who have a medical history of venous thrombosis or in families with a high incidence of venous thrombosis.

Phlebitis

Phlebitis in the strict sense of the word means inflammation of a vein but in a broader sense it is related to venous, superficial or deep thrombosis known by its initials DVT ( deep vein thrombosis ) when they take the deep venous system of the legs or that of the upper limbs.

Deep vein thrombosis is more dangerous than superficial vein thrombosis. DVT of the lower limbs is much more frequent than DVT of the upper limbs but the treatment is similar for both conditions. Starting treatment quickly is very important to avoid complications of which the most severe is a pulmonary embolism known as venous thromboembolism or PE.

Thrombosis and cancer

The appearance of a phlebitis, thrombophlebitis, deep vein thrombosis (all terms that have the same meaning) without apparent cause makes the doctor think about the possibility of a hidden malignant disease.

Fetal loss due to thrombophilia or hypercoagulability

Once other causes of repeated fetal loss have been ruled out, thrombophilia status may be the cause of single or repeated fetal loss. Those factors may be genetic or acquired.

Atherosclerosis and thrombosis

The atherosclerosis is a chronic degenerative disease caused by multiple factors and is characterized by accumulation inside and outside the cell vascular endothelium, lipid (fat), and infiltration of blood elements especially monocyte.

Thrombosis in history

Historically it seems that the first reference to blood clotting was made by Hippocrates in De Carnibus.

Vein with blood clot.

Types of thrombosis

  • Coronary thrombosis:Defines the most common variety of heart attack, and its cause is blockage of a coronary artery due to a thrombus, which interrupts the blood supply to one of the regions of the heart muscle, injuring the tissue of the affected area . The consequence of thrombosis is angina pectoris or myocardial infarction.

Coronary thrombosis is the disease that causes the most deaths in the western hemisphere. However, for every heart attack that leads to death, there are at least two that are not.

  • Cerebral thrombosis: Itcan cause death or paralysis of those who suffer it. This disease occurs when one of the arteries supplying blood to the brain narrows, usually due to atherosclerosis, and the blood supply to the brain becomes so poor that the blood forms a clot in the damaged portion and blocks the artery completely. or partial.

The effect of thrombosis depends on the extent and location of the brain area concerned. It can lead to hemiplegia , with paralysis and loss of sensation in one half of the body, loss of ability to speak, clumsiness of movement, blurred or double vision, confusion and loss of consciousness.

When it affects the right part of the brain, the manifestations occur on the left side of the body, and vice versa. Paralysis tends to improve a few hours after the attack, and recovery includes physical therapy, to restore functionality to the affected limbs, and where appropriate speech therapy. The recovery of the patient depends on the severity of the initial damage, his age and general physical condition, as well as the physical and moral support he receives, and his willpower to rehabilitate himself as prescribed by the doctor.

  • Thrombophlebitis:or inflammation of a vein, usually originates from the formation inside this vein of a blood clot or a thrombus that hinders circulation through the affected vessel. It usually occurs in the veins of the lower limbs. It manifests with pain, itching, redness, hypersensitivity, and edema or swelling. Women experience thrombophlebitis more frequently than men. The people most likely to have them are those who have varicose veins. Treatment includes rest and the administration of anticoagulants to prevent the development of the thrombus and the formation of others. In the most serious cases in which the treatment is not effective, it is necessary to resort to surgery.
  • Deep vein thrombosis:When thrombi form in an inflamed vein near the skin surface, superficial thrombophlebitis occurs, and when they form in an internal vein, they cause deep thrombophlebitis. There are numerous possible causes of this condition, but the most important is due to immobility.

It most often occurs in the legs, but may also appear in the lower abdomen .

It is less frequent than superficial thrombophlebitis, and the elderly and the obese are more prone to suffer them. Deep vein thrombosis has high-risk complications, such as pulmonary embolism, which can be fatal.

Blood clot

Complications

They depend a lot on the type of circulation, since if it is in a terminal site, it is most likely that in the territory where the tissue was occluded, it will die of ischemia . On the other hand, in a territory with sufficient anastomoses, nothing may happen, since the circulation of the extinguished territory is quickly taken over by the collateral.

Diagnosis

Diagnosis is difficult when symptoms are mild, or do not manifest. An accurate diagnosis is made by ultrasound examination of the leg veins. Injection of a contrast medium and catheterization are also used to diagnose the presence of venous and arterial thrombosis.

Important: The symptoms described here corresponding to this disease can be confused with those of other pathologies. To establish a proper diagnosis, always consult your Doctor. Ecured’s goal is to inform and educate, so the descriptions of diseases provided here are not a substitute for professional consultation.

Treatment

The treatment is to inhibit the coagulation cascade and dissolve the thrombi. Enzymatic products that are capable of dissolving the fibrin mesh and platelets are used to recover the permeability of that vessel. And if this recovery of patency occurs before 6 hours after the thrombus is installed, necrosis of that territory can be avoided. For this, an early diagnosis must be made and the patient transferred to the appropriate site within the first 6 hours if possible.

Prevention

  • No Smoking.
  • Try to maintain the right weight.
  • After a surgical intervention it is advisable to get the body moving as soon as possible.
  • Hypertensive and diabetic people must follow their diet strictly and not abandon the medication.
  • Follow a regular exercise program, since thrombosis is less frequent among people who are active or in good physical condition.
  • Women over the age of 35 who take the contraceptive pill should take preventive measures, as the risks of thrombosis associated with the pill increase with age; This risk is potentiated by tobacco use and sedentary lifestyle .

 

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