Hypercoagulable state: Causes, Symptoms, Treatment and Cost

Hypercoagulable state, also known as thrombophilia, is a disorder of the blood clotting system in which the blood has an increased tendency to form clots.

There are several types of hypercoagulable states, including :

• Inherited Disorders: These are genetic disorders that increase the risk of clotting due to abnormal proteins in the body that affect clot formation.
• Acquired Disorders: These are not inherited and can be caused by other medical conditions or medications that increase the risk of clotting due to changes in how the body functions or interacts with certain drugs.

• Hypercoagulable state is caused by a variety of factors, including inherited genetic disorders, certain medical conditions, and lifestyle choices.
• Inherited genetic disorders, such as Factor V Leiden deficiency or prothrombin gene mutation, can cause excessive clotting due to an abnormality in the proteins responsible for blood clotting.
• Hypercoagulability can also be caused by a number of different medical problems, including diabetes, renal illness, and some forms of cancer.
• Certain lifestyle choices such as smoking or taking oral contraceptives may also increase the risk of developing a hypercoagulable state.

The symptoms of a hypercoagulable state can vary greatly depending on the primary cause of the condition; nevertheless, the following are some of the more prevalent symptoms:

• Unexplained bruising or bleeding that lasts for a long time
• Clots of blood that form in the legs (deep vein thrombosis)
• Blood clots in the lungs (pulmonary embolism)
• Stroke or mini stroke (transient ischemic attack)
• Heart attack
• Pain, swelling and redness in one leg or arm
• Abdominal pain and swelling due to blood clots in the veins of the abdomen (mesenteric vein thrombosis)

To prevent hypercoagulable state:

• Consuming a diet that is well-balanced and abundant in fruits and vegetables
• Avoiding smoking and alcohol consumption.
• Maintaining an ideal body weight.
• Controlling stress levels, and taking any prescribed medications regularly.

• Complete blood count (CBC): During this examination, the body's levels of red blood cells, white blood cells, and platelets (also known as thrombocytes) are analysed. Abnormalities in these figures may suggest difficulties with the blood's ability to coagulate.
• Thromboelastography: This test looks at how quickly the blood clots and how strong the clot is. Abnormal results suggest that a person may be more prone to form clots than normal people.
• Prothrombin Time (PT): The prothrombin time is a test that determines how long it takes for a person's blood to clot after being stimulated by a variety of different substances.
• Activated partial thromboplastin time (aPTT): The aPTT measures how quickly certain proteins called plasminogen activators work on your fibrinogen to form fibrin strands which are necessary for clot formation and stability.
• Lupus anticoagulant screen: Lupus anticoagulants are antibodies made by your body that attack proteins involved in normal coagulation processes and can lead to increased risk of forming clots if present in high enough levels in your bloodstream .
• Factor V Leiden mutation testing: Factor V Leiden mutations are genetic mutations which lead to an inability for one particular protein involved in normal coagulation processes, factor V, from being broken down normally by another protein called activated protein C leading to hypercoagulation state if present.

Hypercoagulable can lead to life-threatening complications, such as Deep vein thrombosis (DVT),pulmonary embolism, stroke, heart attack, and even death.

Other complications associated with a hypercoagulable state include recurrent miscarriages, organ damage due to clots forming in the small vessels of organs such as the lungs or kidneys, and development of permanent disability from strokes or heart attacks.

• Ginger: Ginger is known to be an effective remedy for many health issues, including hypercoagulable state. It helps to thin the blood, which lowers the danger of clot formation as a result of this reduced risk. You may accomplish this by drinking ginger in the form of tea or including it into your regular meals. Ginger can be used in a variety of ways.
• Fenugreek Seeds: Fenugreek seeds are rich sources of fibre, vitamins and minerals that help to regulate blood flow and reduce inflammation associated with hypercoagulable state.
• Turmeric: It is well knowledge that the spice in question possesses anti-inflammatory characteristics, which can assist in reducing the inflammation caused by a hypercoagulable condition.
• Garlic: Garlic is known for its anticoagulant effect which helps in preventing clot formation associated with hypercoagulable state.
• Cayenne pepper: Cayenne pepper contains capsaicin which helps to thin the blood and reduce inflammation associated with hypercoagulable state.

• It is recommended to eat a balanced diet that is low in saturated fats and cholesterol
• Your diet should include high in fibre and antioxidants,
• Your diet should include plenty of fruits.
• You should eat vegetables, whole grains, lean proteins, and healthy fats.

Foods to avoid include:

• Red meat such as beef, pork, and lamb
• Meats that have been processed, such as bacon and hot dogs
• Products from the dairy industry that are high in fat, such as whole milk and cream cheese, fried dishes, and other similar items
• Margarine and other spreads made with hydrogenated oils
• Packaged snacks like crackers and chips
• Sweets like cakes, cookies, pies, donuts

• Vascular surgery: This type of surgery may be performed in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) to remove blood clots and improve blood flow in the affected vessels.
• Cardiac surgery: In patients with hypercoagulable states that increase the risk of blood clots forming in the heart or blood vessels of the heart, cardiac surgery may be necessary to remove these clots and repair or replace damaged vessels.
• Orthopaedic surgery: Some patients with hypercoagulable states may require orthopaedic surgery to repair or replace joints that have been damaged by blood clots, such as in case of DVT and PE.
• Spine surgery: If a patient with a hypercoagulable state has a spinal condition, such as a herniated disc or spinal stenosis, and is not responding to conservative treatment, spinal surgery may be recommended to address the problem.
• Neurological surgery: In rare cases, patients with a hypercoagulable state may require neurological surgery, such as an evacuation of hematoma, to treat conditions such as a brain aneurysm, that may be caused by blood clots.

A doctor specialising in haematology or thrombosis should be consulted for the diagnosis and treatment of this condition.

• Anticoagulants: These medications, including as warfarin and heparin, restrict the activation of blood clotting factors, which in turn impedes the development of blood clots. They are often employed in both the prevention of deep vein thrombosis (DVT) and the treatment of pulmonary embolism (PE).
• Thrombolytic agents: These drugs, such as tissue plasminogen activator (tPA), work by dissolving existing clots. They are often used to treat acute ischemic stroke and heart attacks.
• Antiplatelet agents: These drugs, such as aspirin and clopidogrel, prevent the formation of blood clots by inhibiting the ability of platelets to aggregate and stick together. They are often used to prevent and treat heart attacks and strokes.
• Direct oral anticoagulant (DOACs): These drugs, such as Apixaban, Rivaroxaban, Dabigatran and Edoxaban are alternatives to Warfarin, they target specific clotting factors and have more predictable response to treatment.
• Fibrinolytic inhibitors: These drugs, such as Tranexamic acid and aminocaproic acid, work by inhibiting the breakdown of fibrin, the main component of blood clots. They are often used to treat conditions such as heavy menstrual bleeding and surgical bleeding.

It typically takes 6 to 12 months for an individual to recover from a hypercoagulable state.

During this period, the patient should focus on improving their lifestyle habits by eating a healthy diet and exercising regularly.

In some cases, treatment may be able to provide long-term relief from symptoms and reduce the risk of future complications.

In other cases, however, treatment may only offer temporary relief and further monitoring may be necessary to ensure that the condition does not worsen.

• Mobility: Encourage early mobility, it can decrease the risk of blood clots formation.
• Compression stockings: To promote blood flow in the legs, patients may be advised to wear compression stockings during the immediate post-surgical period.
• Monitoring for signs of blood clots: Patients should be closely monitored for signs of deep vein thrombosis (DVT) and pulmonary embolism (PE) after surgery, such as leg swelling, pain, and redness.
• Consultation with haematologist: Consultation with a haematologist may be needed to determine the best course of treatment, especially when there's a genetic or underlying condition as the cause of Hypercoagulability.
• Long-term follow-up: Patients with a hypercoagulable state may require long-term follow-up to monitor for recurrence of blood clots and adjust treatment as needed.

Depending on the patient’s medical history, diagnosis, and other factors, these drugs can cost anywhere between Rs. 1,000 to Rs. 10,000 per month in India.

In addition to medications, patients may also need additional treatments such as clot removal procedures and blood transfusions that could cost up to Rs. 50-70 thousand per procedure.

The most common side effects of treatments for hypercoagulable states include​bleeding, bruising, swelling at the injection site, and pain or redness.Rare side effects may include allergic reactions, blood clots in the lungs or legs, and increased risk of infection.

If you are suffering from any hypercoagulable state then you should consult a doctor nearby as they can have complications like ' Deep vein thrombosis (DVT),pulmonary embolism, stroke, heart attack, and even death.'in which treatment course can range from a few months to years depending on the severity of the situation.