This article has been a hard one to write because of very personal experiences. Early June this year, I lost a good friend of several years after she suffered the effects of a blood clot. The Mass that followed her funeral was for a university student whom we were told had succumbed to the same. 11 months earlier, I had also lost another very close friend to a blood clot incident. 11 years ago, one of my best friends died of the same. It is no longer unusual that we all hear of people dying from clots. I decided to write this article in their memory. It has been a difficult process because the experiences are still very raw for me.
What are blood clots
Blood clots are a protective mechanism intended to prevent us from bleeding non-stop when there is a breakage in any blood vessels. It is a very complicated but fast reaction triggered as soon as the body senses an abnormality in the walls of a blood vessel. Chemicals are released to form a mesh over the abnormal area. Other chemicals make the red blood cells close and stick to the mesh in so doing, forming a plug that stops the bleeding.
How are they developed
Blood clots may develop in the arteries (arterial clots) or veins (venous clots). However, clots may form abnormally or in places where they should not if one of the factors involved in the clotting are altered: the internal lining of the blood vessels, the flow of blood, or the consistency of blood. The abnormal blood clots formed within blood vessels are called thrombi (thrombus if one). The more common clots are those that form in the large veins. They are called deep vein thrombosis (DVT). While many of them can be severe, those that are not moving generally do not cause any problems.
Once a clot is formed in a blood vessel, it keeps growing larger. If, however, a piece of the clot breaks off, it can lead to serious complications, including death. Bits of it may break off and travel to other parts of the body where on their own, they may block the blood supply to vital organs like the heart, brain, kidneys and most deadly, the lungs. These broken-off pieces of clots are called emboli (singular – embolus). The medical condition they cause is called an embolism. When it is in the lung, it is a pulmonary embolism and if not quickly managed, leads rapidly to death by preventing oxygen from getting to the lungs and therefore, to the rest of the body.
Clots in the arteries that are in the brain cause strokes. If they form in the arteries of the heart, they cause heart attacks. Blood clots in the blood vessels of the stomach and intestines may cause pain, nausea and vomiting.
Who is at risk
The risk factors for clots include any one of the following: older age, obesity, pregnancy, long time immobility, for instance, from illness or sitting for long hours with minimal breaks, surgery, an injury like fractures, smoking, oral contraceptives, certain cancers, certain medications including, some vaccines like the COVID-19 vaccine, diseases like COVID-19, diabetes, high blood pressure, high cholesterol, kidney failure treatment, and family history of blood clots.
Treating clots
Clots must be attended to immediately. The plan for treating clots is to prevent them from getting larger, from breaking loose and preventing the person from developing more clots in the future. A person confirmed to have life-threatening clots is given blood thinners to dissolve the clots and prevent the formation of more clots.
Pressure/compression stockings are used to prevent clots from forming. They are used by people who have previously had clots and people at high risk for developing clots.
Sometimes, a device called a stent is inserted to widen the blood vessels to allow blood to pass through freely. Occasionally, large clots are removed using surgery and for those who get clots repeatedly, a filter may be placed in the large blood vessels to catch the clots.
Preventing clots
Some of the risk factors mentioned above can be avoided, for instance, obesity and sitting for long hours with minimum movement. People who are immobile due to sickness should be encouraged to walk if they can try. If they cannot, then they should have physiotherapy to stimulate normal blood flow. The most common risk factor in our community is oral contraceptive use. Unfortunately, in Uganda, oral contraceptives can be bought in pharmacies and drug shops. It is made with no prescription. Consequently, people are increasing their risk of getting abnormal clots.
By Dr. Miriam Laker-Oketta
