strokes/blod clots

    
      Re: strokes/blod clots
    


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Posted by CCF NEUROSURGERY MD on October 09, 1997 at 11:25:04:

In Reply to: strokes/blod clots posted by Pam Daigle on October 05, 1997 at 21:11:44:

: My father had a stroke in June. They kept him in the hospital about 3
  weeks. That included 1 1/2 weeks in rehab. On Sept. 15 he had another
  "stroke" we were told. He has a clot in the stem of the brain and one
  in the heart. He has been on hepherin now for 3 weeks. The doctors have
  said that this will not dissolve the clots. If this medications does not
  dissolve closts why is it given to patient with clots? He is also on
  ticlid(sp?) to make the clot in the heart adheare to the wall of the
  heart. Neither process seems to be working. Just need information
  on these drugs and their use in dealing with clots and stroke victims.

  Thank you very much.

  Pam Daigle
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Dear Pam,

Heparin is an IV medication that prevents clots from forming.  It does nothing
to dissolve the clot already present.  Heparin is usually given at a specific
rate to maintain therapeutic levels in the body.  When stopped, heparin's
effects will wear off in four to six hours.  It is effective immediately
and therefore is used acutely in the hospital setting alone.  The body will
dissolve the remaining clot on its own.

There exist other anticoagulants that can be taken orally and work by
different mechanisms.  Ticlid is a medicine that inhibits platelets from
sticking together.  This is the initial process in clot formation.  Aspirin,
not Tylenol or aceteminophen, works on platelets in a similar fashion to
prevent them from sticking together.  Coumadin, or Warfarin, is yet another
medication that inhibits the coagulation cascade that occurs after platelet
aggregation.  There are different indications for each and a physician
should be consulted before taking any of these medications.

You may be confused by now.  Briefly, the coagulation cascade is an intricate
series of reactions that result in clot formation.  For example, you skin
your knee and it bleeds a bit.  Initially, platelets from the blood will
stick together to form a plug and physically stop the bleeding.  This is
temporary.  Next ensues a detailled cascade of events that results in the
formation of a clot and eventually a collagen scar.  There are many places
in the coagulation cascade where there is feedback on the previous stages.
This is a controlling mechanism the body uses so it doesn't form more clot
than is necessary.  There is also a system for the body to dissolve clots, equally
as intricate.  Got it?

Incidentally, there also exist IV medications to dissolve clots.  They are
used in acute strokes, clotted vascular grafts and clotted central IV lines.

Clearly the issue of clots is big business in medicine.  There is much
research going on both in the basic science realm and clinical studies for
the newest medications.  

Here's hoping this cleared things up a bit.

Good luck.