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Coagulation Corner

Monday, December 5, 2016


Written By Donna Castellone, MS, MT (ASCP) SH | LinkedIn


Welcome to the Holiday edition of Coagulation Corner! No matter what your beliefs or what group you belong to or do not belong to, everyone celebrates something. They may not be the same day for everyone, but working in a diverse environment and talking with people, there are similarities. They involve family, food, travel and many times stress! How does coagulation work its way into these events, stay with me, and I will show you.

Let's first take a look at families and I don't mean Uncle Paul's lame jokes or Aunt Jane's long stories, but look at the history they provide. What I mean is their coagulation history. Family history is one of the most important tools in the assessment of a bleeding or clotting disorder. Is there a prevalence of clotting: MI, strokes, Arteriosclerosis, peripheral arterial disease or atrial fibrillation? What about bleeding? Platelet disorders, women in the family with heavy menses? It may not be "we all tend to bleed", there may be a reason. It is important to also consider additional acquired factors- are they obese, do they smoke are the sedentary, these can all contribute to a thrombotic risk. So there is more than we all have curly hair, or no hair as the case may be.

The center of most celebrations is food! Of course if we could restrict it to just one day, that wouldn't be so bad, but no the more the merrier. So we indulge and what impact does the have on our coagulation factors? First let's look at salt. We know that it elevates blood pressure, even though the mechanisms are not well understood. However, excessive salt can reduce the function of the endothelium which is an essential component in platelet adhesion and immune function. It has also be shown to enlarge the muscle tissue of the heart.

Next to consider is fat. It has been noted that a diet high in fats can increase coagulant activity. As long ago as 1954, Cullen et al conducted studies in hamsters that demonstrated a diet rich in animal fat causes a rise in adhesiveness in platelets. More recent studies how that lipemia can promote formation of occlusive thrombin, resulting in increased fibrin deposition on surfaces all contributing to thrombosis.

Least a meal not be complete without sugar! What effect does hyperglycemia have on coagulation? It has been shown that patients with acute coronary syndrome and increased glucose levels have a worse prognosis. Elevated glucose has been associated with enhanced thrombin generation, activation of FVII and platelet activation.

So far, any meal seems to be a health hazard, however wine, in moderate consumption appears to have some protective effects. One hundred studies have shown an inverse association between moderate drinking and the risk of heart attack and ischemic stroke resulting in a 25-40% decreased risk. This can raise HDL levels, improve tPA, fibrinogen, FVII and vWF which can prevent the formation of blood clots that may block arteries. Of course you need to balance alcohol consumption with the risks.

The next food group to discuss is chocolate! A recent study showed that when a group was given flavonoid rich dark chocolate versus a placebo group and underwent physiological stress tasks, four prothrombotic measures were tested. These included fibrinogen, FVIII, vWF and d-dimer. The d-dimer was significantly reduced in the dark chocolate group relative to the placebo. These findings may mitigate the risk of acute coronary syndromes triggered by emotional stress. Do we need more studies to eat chocolate? I think we are good. Probably a good idea to have some on hand when shopping and standing in a long line.

Travel, in particular, airline travel has become a chore, gone are the days of an exciting adventure which included a meal and happy travelers. Now you are practically strip searched, squished into a seat, not to mention your six ounce glass of water. You need to prevent dehydration. This can cause blood to become acidic pulling water out of the cells of arterial walls which become weakened. Blood also flow slower when you are dehydrated and makes it difficult for the heart to pump but can grab onto plaque and carry it to an organ, resulting in a clot. To make matters worse, you are in a confined space. If you are sitting for more than 4 hours the greater the risk of developing a blood clot. Economy class syndrome has been described due to long periods of inactivity caused by space limitations which can slow circulation and produce edema. Low oxygen, humidity and cabin pressure have a dehydrating effect on the blood and can contribute to clot formation. This of course is increased with acquired and inherited risk factors, with Factor V Leiden being the most prevalent. In a study that compared thrombin levels in subjects who flew versus those who sat immobilized for 8 hours, found a 223% rise in levels versus 46%. So there must be some other contributing factor other than immobility that causes this. So why not take an aspirin? You can, but remember, aspirin is protective against clots formed by platelets. It will not prevent a DVT which are clots caused by red blood cells. Nonetheless, the aspirin will also help you with your headache you got from trying to fight your seat mates for your position on the arm rest!

Well, all this really makes you want to hide and emerge after the first of the year. But, there are many instances of good feelings, times and memories that are associated with holidays. The WHO has studied the Happiness Effect and have concluded that warm intimate relationships are the most important prologue to a good life which leads to health and a longer life.

So I wish for all of you to experience your celebrations with awareness, and look for the happiness and joy. Enjoy this time, moderation is the key, learn about family history and keep a piece of dark chocolate available at all times.

All the best to you and your family!



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