Thrombosis

• Thrombosis is a serious condition where a clot forms inside a blood vessel

(an artery or vein) in your body or sometimes inside of your heart.
• This is dangerous because clots that form inside blood vessels can block
blood flow.
• They can also break free and travel elsewhere in your body, and if a clot
gets stuck in a critical location like your lungs or brain, that can cause life-
threatening emergencies.
 Types of Thrombosis

• Thrombosis falls into two categories, depending on the type of blood vessel
where it starts.
• Arterial thrombosis
 This is thrombosis that happens in arteries, which are blood vessels that carry
blood from your heart to the rest of your body.
 Arterial thrombosis is the most common cause of heart attacks and strokes.
• Venous thrombosis
 This is thrombosis that happens in veins, which are blood vessels that
carry blood back to your heart from your body.
 Venous thrombosis is the most common cause of pulmonary embolism
(blood clot in your lung).
 Most common types of thrombosis

• Deep Vein Thrombosis (DVT)

 A "deep vein" is farther inside your body, away from your skin. DVT mainly
happens in your leg or pelvis (lower-extremity thrombosis), but you can
get it in your arm or shoulder (upper-extremity thrombosis), too.
 Small clots sometimes dissolve on their own.
 Big clots that don't move or go away can block blood flow in the vein.
 They're dangerous if they break off because they could travel to your
lungs.
• Pulmonary Embolism (PE)

This is a blood clot that formed somewhere else and has traveled through your
bloodstream to your lungs. Most often, it's from a vein in your leg or pelvis. It
can block the flow of blood in your lungs. It can also harm other organs
because your lungs can't supply them with enough oxygen. If the clot's very
large or you have more than one, PE can be fatal.

• Femoral Vein Thrombosis

This is a clot in the long vein in your thigh. It usually doesn't cause symptoms,
but sometimes you could have swelling, redness, and pain in your leg. Femoral
vein clots can happen for many reasons: after surgery, when you're on bed
rest, or if you sit for a long time, take birth control pills, or have had DVT
before.
• Paget-Schroetter Syndrome (PSS)

It's a rare kind of DVT that typically happens to a young, healthy person who
plays sports that use the upper arms a lot, like swimming and baseball. The vein
can get squeezed by the muscles around it. This pressure, along with repeated
movements, can cause a clot in your shoulder. Symptoms like swelling, chest
pain, and a blue color to your skin may come on suddenly. PSS can be serious if
it's not treated right away.

• Myocardial Infarction (Heart Attack)

Your heart's arteries can get clogged with a sticky fat called plaque. A clot that
forms on the plaque could cut off blood flow to your heart. If it's not treated
quickly, part of your heart muscle may die. A heart attack usually causes a
squeezing pain in your chest. Women might have other symptoms, like back
pain or fatigue.
• Superior Vena Cava Thrombosis

This big vein in your chest returns blood from your upper body to your heart.
You usually get this type of clot if you have a tube called a central line (used to
carry medicine into your body) or a catheter in the vein. Your doctor might
take out the tube to treat the clot or leave it in. Either way, you'll probably
need blood thinning medicine to prevent more clots.

• Jugular Vein Thrombosis

The two sets of jugular veins in your neck bring blood from your head and
neck back to your heart. Clots tend to form in these veins when you have a
central line in them. Cancer, surgery, or using IV drugs can also cause jugular
vein thrombosis. These clots might break loose, travel to your lungs, and
become PEs.
• Thrombotic Stroke

When a clot blocks blood flow in one of your brain's arteries, that part of your
brain starts to die. Warning signs of a stroke include weakness in your face and
arms, and trouble speaking. If you think you're having a stroke, you must act
fast. It may cause lasting problems with talking or using one side of your body.
The sooner you're treated, the better chance your brain has of recovering.

• Cerebral Venous Sinus Thrombosis

This is a rare type of stroke. A clot in this part of your brain stops blood from
draining out and back to your heart. The backed-up blood can leak into brain
tissue and cause a stroke. This mainly happens in young adults, children, and
babies. A stroke is life-threatening.
• Cavernous Sinus Thrombosis

It doesn't happen often, but a blood clot can form in a vein that runs through
the space behind your eye sockets. The most common cause is an infection
that spreads from your nose, face, or teeth. Other things, like a head injury,
can cause it, too. The main symptoms are eye problems. Your eyes may hurt,
seem irritated or swollen, or bulge out, or you could find it hard to control
their movements.
• Retinal Vein Occlusion

It's one of the most common reasons older people lose their sight. A clot that
blocks blood flow in the central vein in your retina (the tissue lining the back
inside of your eye), or smaller side veins, stops blood from draining from your
eye. The blood leaks out and can lead to serious vision problems, like
glaucoma or a detached retina.
• May-Thurner Syndrome

Your right iliac artery carries blood to your right leg. Your left iliac vein brings
blood from your left leg back to your heart. These two blood vessels cross in
your pelvis. Normally, that's not a problem. But in someone with May-Thurner
syndrome, the artery squeezes the vein against the spine, making a clot in your
left leg more likely. It's something to consider when a young woman has
sudden swelling in their lower body.

• Portal Vein Thrombosis

The portal vein carries blood from your digestive tract and spleen to your liver.
People with cirrhosis or who are prone to clots could get one in it. A small clot
usually doesn't cause symptoms. But if pressure builds up in the vein behind
the clot, you could get an enlarged spleen, swollen belly, and bleeding.
• Budd-Chiari Syndrome

• A blood clot narrows or blocks the veins that carry blood from your liver to
your heart. It's not the same as portal vein thrombosis, but it has some of
the same symptoms, including a large spleen, swollen belly, and bleeding.
The main problem is with your liver. It doesn't work as well as it should. If
it's very damaged, you could need a liver transplant.
• Renal Vein Thrombosis

• A kidney disease called nephrotic syndrome can cause a clot in either of

the veins that carry blood away from your kidneys. You might not have
symptoms with a slow-growing clot. A clot that happens suddenly can give
you low back pain and blood in your pee. When you have only one kidney
or clots in both veins, your kidneys could stop working.
 Causes of thrombosis

• Disease or injury to the leg veins

• Not being able to move around (immobility) for any reason
• A broken bone (fracture)
• Certain medicines
• Obesity
• Inherited disorders, or a greater likelihood of having a certain disorder based
on your genes
• Autoimmune disorders that make it more likely your blood will clot
• Medicines that increase your risk of clotting (such as certain birth control
medicines)
• Arterial thrombosis may be caused by a hardening of the arteries, called
arteriosclerosis. This happens when fatty or calcium deposits cause artery
walls to thicken. This can lead to a buildup of fatty material (called plaque)
in the artery walls. This plaque can suddenly burst (rupture), followed by a
blood clot.

• Arterial thrombosis can occur in the arteries that supply blood to the
heart muscle (coronary arteries). This can lead to a heart attack. When
arterial thrombosis occurs in a blood vessel in the brain, it can lead to a
stroke.
 Risk factors for thrombosis
• Many of the risk factors for venous and arterial thrombosis are the same.
• Risk factors for venous thrombosis may include:
 A family history of a blood clot in a vein deep in the body, called a deep
vein thrombosis (DVT)
 A history of DVT
 Hormone therapy or birth control pills
 Pregnancy
 Injury to a vein, such as from surgery, a broken bone, or other trauma
 Lack of movement, such as after surgery or on a long trip

 Inherited blood clotting disorders

 A central venous catheter

 Older age

 Smoking

 Being overweight or obese

 Some health conditions, such as cancer, heart disease, lung disease, or

Crohn's disease
Risk factors for arterial thrombosis may include:

• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Lack of activity and obesity
• Poor diet
• Family history of arterial thrombosis
• Lack of movement, such as after surgery or on a long trip
• Older age
 Symptoms of thrombosis

Each person’s symptoms may vary. Symptoms may include:

• Pain in one leg (usually the calf or inner thigh)

• Swelling in the leg or arm
• Chest pain
• Numbness or weakness on one side of the body
• Sudden change in your mental state
 Diagnosis

• Physical exam

- A physical exam is where a doctor looks at different areas on your body for
visible signs of a problem. They’ll also feel areas of concern (for problems like
swelling, tissue changes or temperature changes), and listen to your heart,
breathing and digestive system.
- In cases where they suspect thrombosis in your arms or legs, they might listen
to the sound of your pulses in your affected limb. That can help them figure
out the approximate location of a clot.
 Imaging tests
• Healthcare providers will use a wide range of imaging tests. These tests help with
diagnosing and locating blood clots, as well as guide treatment.
• Some of the possible tests include the following methods:
 X-rays. This also includes computed tomography (CT) scans, which use a computer
to assemble X-ray images into a 3D picture of the inside of your body. These
methods may also involve substances that a healthcare provider injects into your
body. These substances are highly visible depending on the imaging method, which
can help highlight any areas where blood isn’t circulating.
 Ultrasound. Tests that use this involve ultra-high-frequency sound waves that help
generate a picture of the inside of your body.
 Magnetic resonance imaging (MRI). This imaging method uses a very powerful
magnet and computer processing to create a high-resolution picture of the inside
of your body.
 Laboratory tests
• Because clotting is something your blood does naturally, lab tests on your
blood can help analyze and determine if your blood clots too easily. These
tests can also help discover why your blood is clotting and can help decide
on possible treatments.
• These tests usually look for the following:

- Blood components. This includes several tests that measure certain types of
blood cells like platelets and chemical compounds, especially ones that
affect clotting.
- Clot-formation markers. These are chemicals that typically only show up in

your blood if you have a clot at the time. They can help healthcare providers

confirm or rule out an active clot as the source of a blockage.

- Heart damage markers. An example of this is troponin, a protein found in

muscle cells. Your heart muscle cells contain a very specific type of troponin

that doesn’t occur elsewhere in your body. Damage to your heart cells, such

as from a heart attack, causes troponin to leak out of those cells and into

your blood. Tests that detect troponin can help confirm or rule out heart

attacks, which often happen because of thrombosis.

 Treatment
• Treatment of thrombosis depends strongly on why it’s happening and
what parts of your body it affects. In some cases, such as when it’s
happening because of a genetic or inherited condition, thrombosis is
potentially treatable but not curable.
• Treatment of thrombosis can take several different forms. It can involve
medication, surgery, minimally invasive catheter procedures and more.
• In many cases, thrombosis treatment starts with prevention, keeping clots
from forming and becoming a danger.
• Treatment of thrombosis can involve any — including various combinations — of the
following:
• Preventive medications
• Preventive treatments for thrombosis typically involve a few different classes of
medications.

- Blood-thinners. These medications keep your blood from clotting too easily. There are

different types of blood-thinners, including antiplatelet, anticoagulant and fibrinolytic

drugs.

- Blood pressure-lowering medications. Over time, high blood pressure puts too much
stress and wear on the inside of your blood vessels. This kind of wear and tear can
make it easier for blood clots to form and grow on your vessel walls. Blood pressure
medications prevent clots by not giving them new places to form.

- Cholesterol-lowering medications. Your cholesterol levels directly influence the buildup of

plaque on the inside of your blood vessels. Lowering your cholesterol limits that
buildup.
 Acute medications

• Acute blood clots (meaning they started very recently) are also treatable with

medications. These medications usually include the following:

• Blood-thinners (for the same reasons mentioned under “Preventive

treatments” above).

• Clot-busting drugs. These drugs break down existing clots, which is especially

helpful when a clot is in a critical area. Drugs like this are common in the

treatment of heart attack, stroke and other thrombosis-related conditions.

• Healthcare providers may also prescribe other medications, such as pain

medications or blood pressure medications, which will ease your symptoms

and improve blood flow.

 Surgery and catheter procedures

• Depending on the location and size of the clot, healthcare providers may
be able to go in and remove the clot directly. This kind of clot removal,
known as thrombectomy, can happen in a few different ways:

- Surgery. One of the most direct ways to remove a clot is for a surgeon to
access it directly and remove it. In some cases, they may also use surgery
to do a bypass, where the surgeon takes a section of blood vessel from
elsewhere in your body and uses it to construct a bypass, or detour,
around an area of another blood vessel that’s very narrow. This restores
blood flow to the affected parts of your body.
• Catheter procedures. These types of procedures use a long, thin, tube-like
device called a catheter. A healthcare provider inserts this device into a
major blood vessel somewhere on your body and steers the catheter
through your blood vessels to the blocked area. Once there, they can use
devices on the tip of the catheter to break apart and suck up the clot
fragments (rheolytic thrombectomy), and/or inflate a small balloon on the
tip of the catheter to widen narrow sections of a blood vessel. They can also
sometimes place a stent, a scaffold-like device, which acts as a support to
hold your blood vessel open.