This conversation is presented by Grifols, a leading global healthcare company specializing in plasma-derived medicines, biopharmaceuticals and transfusion medicine helping millions of patients around the world.
Listen to the full conversation by clicking the link above as 97.9 The Hill’s Aaron Keck has an in-depth conversation with Prof. Aryeh Shander about thrombophilia, critical care and progress in medical science. Below, you’ll find a transcript of their conversation, lightly edited for clarity.
Aaron Keck: We are gonna continue by talking about a critical health issue that may affect you or someone you love. It’s a condition called thrombophilia, which a lot of folks have without being aware of it, and it can put you at higher risk of life-threatening blood clots. We’re joined on the phone by Dr. Aryeh Shander, an anesthesiologist and critical care specialist for a conversation presented by Grifols, a global biopharma company that’s been working alongside the National Blood Clot Alliance to raise awareness about the issue. You can learn more about the risks and the symptoms and prevention tips online at stoptheclot.org. Dr. Shander, thank you so much for being with us today.
Dr. Aryeh Shander: My pleasure, and thank you for addressing this very important topic.
Keck: So, just to get us started, what is thrombophilia and why is it important?
Shander: That’s a very good question. I think the audience seems to be aware that the term “thrombophilia” reflects a genetic disposition that alters some of the proteins in the blood that protect the person from inappropriate clotting. Many people are unaware of the fact that blood is in a constant motion between clotting and declotting. The balance is very essential, and if disturbed, um, and is reduced, one side is reduced in this equation of clotting and declotting, it can result in, either bleeding or conversely, it can be a serious clot, which can either have significant impact on the patient’s quality of life or even death. Antithrombin is one of the protective proteins which is produced by the liver and protects the person from inappropriate clotting. And there’s several different types of genetic thrombophilia and one of which is antithrombin deficiency, where you’re deficient in that protein.
Keck: So, when do you encounter those patients and what types of complications might they face?
Shander: That’s another very good question, Aaron. It’s important to note that genetic thrombophilia is another as where as many think, in fact, actually we are starting to recognize that our, they’re becoming a little more common. They’re very different from one another, but we need to get the awareness up there. The main concern, though, with these genetic forms of antithrombin deficiency specifically, is the increased risk of blood clot and the associated consequences. We often see some of these patients present in a hospital setting related to surgery, critical care, or pregnancy. Again, these are very stressful situations for patients with a main complication, again, as being a blood clot that can have serious consequences. I already mentioned prior to this. The other issue with hereditary antithrombin deficiency is the lack of heparin response. Heparin, again, is an anticoagulant that we use very frequently. It is our first line treatment for many of these conditions where there is a risk of thrombosis, but without sufficient level of antithrombin, heparin becomes ineffective. And again, this is referred to, at least in our world, as referred to as heparin resistance. Those patients may need antithrombin replacement in addition to heparin to make it work effectively.
Keck: Blood clots, I know, can be an extra big risk and particularly stressful health times when folks are having surgery, if folks are pregnant, during critical illnesses. I know we had that in my own family. I had a close family member that was going through cancer treatment and had a pulmonary embolism from a blood clot. What is it that causes that and what does that mean for folks with antithrombin deficiency where they’re higher at higher risk in the first place?
Shander: So, as you already mentioned, you have family history. Thromboembolic disease represents a serious risk to those who are affected with any imbalance, as mentioned before, between the clotting and declotting. So, patients who have surgery, for me, the reasons as well as critical illness and pregnancy patients have an increased risk of what we call thromboembolic disease, of venous thromboemboli due to a combination factors like immobility, the injury itself, and of course physiologic changes, which occur as an example in surgery where your immune system or inflammatory system is affected, which again, is a risk for thrombosis. If these symptoms, such as repeated miscarriages or pulmonary embolism, can lead again to death and are not identified and managed early, we know that patients with hereditary antithrombin deficiency at a much higher risk of VTO of venous thromboembolism than those with other thrombophilias, because antithrombin is either absent or not functioning properly, making blood clots much more likely to form in these high risk situations. So, I think the index of suspicion is higher in the patients who have any kind of increased stress, such as surgery mentioned critical illness and pregnancy.
Keck: Speaking with Dr. Aryeh Shander, and again, this conversation presented by Grifols, you can get more information about thrombophilia and blood clots and how to prevent them at stoptheclot.org. So, what are some signs or risk factors that would make you think someone ought to be checked for thrombophilia?
Shander: I think that’s a great question. I think it’s a very important, so any person presents with a history of unprovoked venous and or arterial thrombosis or thromboembolism, especially if they’re younger patients or they present with thrombosis in unusual sites. Again, miscarriages which are unintended renal fareal of unknown etiology or history of heparin resistance, those patients should be screening for thrombophilia antithrombin deficiency. More importantly, a careful family history of any of these above scenarios should prompt investigation. That is, we should never just not address it once we get this type of history in the patient.
Keck: So how do you diagnose antithrombin deficiency and then with patients who do get diagnosed, what do you do differently with them or for them?
Shander: One of the, the things that we do is we look for those histories that I just mentioned in terms of having any kind of unprovoked thrombosis or, again, in a pregnant women, if they’ve had multiple miscarriages. Once we have the screening done, meaning getting the history in the patients, we can actually look for levels of antithrombin in these patients and make the diagnosis that way.
Keck: Should we just screen people routinely? And if not, when should we?
Shander: That’s a very good question. I think that the idea here is that the first step in screening patients is to get a history. So, that if the history itself is suggestive, even remotely suggestive, such as what you brought up before, which is a family member having an incidence of venous thromboembolism that should prompt investigation. The investigation again, is gonna rely on the history of the patient, the scenarios we described prior, and then of course getting levels and making that diagnosis, both with laboratory as well as history.
Keck: Speaking again with, uh, Dr. Aryeh Shander talking about thrombophilia, which is a very critical medical condition that folks should know about. For folks who are concerned about their risk of blood clots, especially if they’re heading into pregnancy or surgery or any of these other risky times that we’ve talked about, what’s your general advice to them?
Shander: So again, these individuals who have this type of history, clearly good candidates for further evaluation and screening, testing and the workup was negative, it would put them at ease. But if it’s positive meaning, findings are suggestive that they are at risk, then this has to be managed, and that’s done on an individual basis, depending again, on what is the scenario they’re gonna be facing, whether it be surgery, whether it be pregnancy, et cetera.
Keck: And just since we’re talking about this issue to raise awareness, what’s your advice to, to folks in general to, to patients, potential patients, doctors and and everyone else?
Shander: I think that the advice is to let them know that this is not a benign condition and that these individuals who are at risk need to be managed and those who think that they are at risk but are not, again, could be put at ease as mentioned already before, getting awareness up and the index of suspicion if there is either a family history or they encounter any kind of, the scenarios that we’ve addressed before should be followed and, and again, cared for on individual basis.
Keck: Speaking again with Dr. Shander, and as we wrap up this conversation, if people want more information, where can they go?
Shander: So, there are a large number of both international as well as national organizations that have materials that they put out, including videos. Anyone who’s concerned or wants to learn more about it, and again, may be because you have a neighbor or a family member, they all address some of the risks that we just addressed today in our conversation. But some of these organizations include the National Blood Clot Alliance, or NBCA, the American Society of Hematology or ASH. There’s the International Society for Thrombosis and Hemostasis. They have a lot of information on their website and actually the resources you can delve into very deeply as you work with these organizations, especially if you have any concerns. There’s another one up in Canada, which is called Thrombosis Canada, but this is just a few of a very long list of organizations that deal with thrombophilia and the risks of clotting as well as bleeding.
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