Lots of clots Dr Tom Mabin Vergelegen Mediclinic Somerset West October 16th 2015 Helderberg Cardiac...
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Transcript of Lots of clots Dr Tom Mabin Vergelegen Mediclinic Somerset West October 16th 2015 Helderberg Cardiac...
lots of clots
Dr Tom Mabin
Vergelegen Mediclinic
Somerset West
October 16th 2015
Helderberg Cardiac Support Group Seminar
Foul play….clots however can form in unwanted area within the blood vessels of the body.
• Coronary artery = myocardial infarction (heart attack)
• Brain artery = stroke
• Leg vein lungs = pulmonary embolus
• Left atrium brain = stroke
The penalties………
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
The sequence of clot formation in the arteries and where the drugs work
Red blood cells
+
=
Clot (thrombus)
Anti-plateletsAspirin
clopidogrel
Antithromboticsheparin
Thrombolytics“clot busters”
IV drugs
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 need to be inhibited using aspirin and clopidogrelifigStents can play a vital role in busting up the clot and clearing the plaque. Again, time is
the factor
Direction of blood flow….
Veins flow back to the heart: slow flow and sluggish
Arteries flow
away from the heart: rapid flow high
pressure
Another common area of slow flow and clot formation is in the left atrium of the heart after atrial fibrillation has developed
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• Single daily dose• Rash• bleeding
Pradaxa• Twice a day• Care with kidney function• Indigestion• bleeding
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:ASPIRINCLOPIDOGREL(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 withWARFARINXARELTOPRADAXA
Different strokes for different folks…who takes what?Aspirin or clopidogrel• Angina• Heart attack• Stent• Bypass• Stroke• TIAany arterial disease
Warfarin or NOAC• Atrial fibrillation• DVT• Pulmonary embolus