This website mostly covers the blue (blood clot) team, that is clots that occur in the venous system, like DVT or PE. However the last two diagnosis posts covered stroke and heart attack which happen when clots occur in arteries, so the red (blood clot) team. I thought it might be a good idea to compare and contrast the two teams.
You will note that I haven’t kept to the same sport for each team; I really am clueless about sports, so please don’t read anything into that!
Blue Team
clots in – venous system – blue, deoxygenated blood. Veins carry blood from the tissues back to the heart, the pressure in the vessels is low and the blood flow is slow. Clots start where the blood flow is at its slowest. In the legs that is in the turbulent blood flow at the site of the small valves in the leg veins. If for some reason a clot starts to form, the activated clotting factors can accumulate at that spot and the clot can then grow. The clotting factors in the blood are key to this process. Anticoagulants are the mainstay for preventing clots in veins.
conditions –
- DVT (deep vein thrombosis),
- pulmonary embolus,
- thrombus in left atrium in patients with atrial fibrillation (in AF the atrium doesn’t contract properly so it becomes a low pressure chamber where a thrombus can form even though it is full of oxygenated red blood)
risk factors – immobility, cancer, thrombophilia, pregnancy – we will be covering a journal article about the main risk factors next week
treating the clot –
- It is very unusual to try to remove the clot – thrombolysis or surgical removal are only used in unstable life threatening PE. Otherwise touching the clot is likely to cause vessel scarring making further clots more likely.
- Instead anticoagulant treatment makes the blood less likely to clot, so preventing new clots forming or the present clot growing bigger
preventing another clot –
- anticoagulant treatment with warfarin or a NOAC (eg. Dabigatran or Rivaroxaban)
- support stockings after a DVT
Red Team
clots in – arteries – usually those supplying blood to the heart or brain, but sometimes to those supplying blood to the limbs or intestines. Arteries carry blood at a higher pressure than in veins and it flows faster. Blood clots in arteries are thought to start when platelets are activated by the damaged lining of the blood vessel. These platelets stick together and form a focus for the clot to form. Antiplatelet drugs are the mainstay for preventing clots in arteries.
conditions – cardiovascular disease (CVD) – heart attacks, strokes and transient ischaemic attacks (TIAs).
risk factors – An article in the Lancet in 2004 showed that 90% of heart attacks are due to 9 risk factors all of which can be modified (unlike being male and being older which are also risk factors)
I’ve tried to make them easy to remember by fitting them to the words LOSS and DEATH
- Lipids (high cholesterol etc)
- Obesity (especially abdominal fat)
- Smoking
- Stress
and DEATH
- Diabetes
- Exercise (not getting enough)
- Alcohol
- Tucker – sorry, this is the only one that didn’t easily fit! so it stands for your diet!
- Hypertension
treating the clot –
- The mainstay of treatment is to try to remove the clot – using thrombolytic drugs or surgical techniques to bypass the clot such as putting in a stent or grafting in another vessel (CABG – coronary artery bypass graft). During surgery, the clot can sometimes be sucked out or removed.
- Anticoagulants may be given to people in hospital but this is to prevent the occurrence of DVTs rather than being related to the arterial clot
preventing another clot –
After an arterial clot, people are put on medication that affects platelets to make the blood less likely to clot for example aspirin, clopidogrel or ticagralor. These drugs prevent platelets sticking together, they work in a different way to anticoagulants which affect clotting factors rather than platelets.
And what about the PURPLE team?
We need to have a purple team now, as it’s becoming more and more apparent that the red and blue teams are not always as different as was traditionally thought.
For example people with atrial fibrillation are on anticoagulants (associated with the blue team) to prevent atrial thrombus but their AF may be due to a heart issue so they are often at higher risk of cardio-vascular disease (the red team).
Risk factors such as lack of exercise are common to both teams: We covered the journal article about PE risk in ‘Could too much TV kill you?’
We plan to start a medical series covering the main risk factors for clots soon.
Which team most describes you?
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