Why do blood clots form?
Normally, the coagulation and anticoagulation systems balance each other: the blood stops in the wound, but does not coagulate in the vessels. With thrombophilia, the balance is shifted, and a blood clot forms more easily. But one predisposition is usually not enough: a second factor is needed that slows down the blood flow or damages the vessel. Therefore, most thromboses occur after operations, injuries, long-term immobilization, during pregnancy and the postpartum period, against the background of cancer. It is the combination of permanent and temporary risk that determines prevention tactics.
- Hereditary forms: factor V Leiden mutation, prothrombin mutation
- Deficiency of natural anticoagulants: antithrombin III, proteins C and S
- Antiphospholipid syndrome - acquired form
- Hyperhomocysteinemia
- Thrombophilia in cancer
- Combination of several risk factors
Who needs testing and when?
Wholesale screening for coagulation mutations is not recommended: in many people, common gene variants are found, which in themselves do not change tactics and only cause alarm. The examination is reasonable for thrombosis at a young age, thrombosis without an obvious cause, thrombosis of unusual localization, repeated episodes, as well as a family history of thrombosis in close relatives. In obstetrics, indications include repeated pregnancy losses, severe preeclampsia, fetal growth restriction and placental abruption in the past.
- Thrombosis under 50 years of age
- Thrombosis without a provoking factor
- Repeated thromboses
- Thrombosis in close relatives
- Thrombosis of unusual localization: abdominal veins, cerebral sinuses
- Repeated pregnancy losses and severe obstetric complications
- Planning hormonal therapy for family history
Thrombophilia and pregnancy
Pregnancy itself increases blood clotting: this is a natural mechanism of protection against blood loss during childbirth. With thrombophilia, the risk increases even more, especially in the third trimester and in the first weeks after birth. With antiphospholipid syndrome, blood flow in the placenta is impaired, which is associated with pregnancy losses and complications. The management of such a pregnancy is planned in advance together with an obstetrician-gynecologist and hematologist: the need for prophylaxis is determined, medications that are safe for the fetus are selected, and more frequent monitoring and ultrasound with Doppler ultrasound are prescribed.
- Pregnancy planning together with an obstetrician-gynecologist
- Assessing individual risk, not just genetic findings
- Low molecular weight heparins as prescribed by a doctor
- Low dose acetylsalicylic acid for antiphospholipid syndrome
- Regular ultrasound and Doppler testing
- Continuation of prophylaxis after childbirth at the appointed time
- Compression jersey
What tests are taken?
A basic coagulogram shows the general state of coagulation, but does not reveal thrombophilia. For antiphospholipid syndrome, lupus anticoagulant and antiphospholipid antibodies are determined, and the test is repeated after 12 weeks, because a single increase is temporary after infection. Antithrombin III, proteins C and S, and homocysteine are also determined. Genetic tests are taken once, their results do not change over time. The moment of delivery is also important: against the background of acute thrombosis and taking anticoagulants, some of the indicators are distorted.
- Basic coagulogram
- Lupus anticoagulant and antiphospholipid antibodies twice at intervals
- Antithrombin III, proteins C and S
- Homocysteine
- D-dimer for suspected active thrombosis
- Genetic tests for coagulation mutations according to indications
- Ultrasound of the veins of the lower extremities with Dopplerography
Prevention and treatment
If there has been no thrombosis, and only a predisposition has been identified, constant use of anticoagulants is usually not necessary. The main thing is enhanced prevention during periods of increased risk: after operations, during prolonged immobility, during pregnancy and after childbirth. If thrombosis occurs, the doctor prescribes anticoagulants, and the duration of use depends on whether there was a provoking factor and whether the episodes recurred. With antiphospholipid syndrome, treatment is often long-term. Any medications that affect coagulation should only be selected by a doctor; discontinuation on your own is dangerous.
- Prevention during periods of increased risk
- Early activation after surgery
- Stay hydrated and warm up on a long journey
- Compression hosiery according to purpose
- Quitting smoking and losing weight
- Discussing hormonal contraceptive therapy with your doctor
- Anticoagulants according to the schedule and under the supervision of a physician
- Informing surgeons and obstetricians about the diagnosis before interventions
