Blood clot questions...

[aachavez]

I'm still in fundamentals so I know these questions probably seem pretty rudimentary or silly, but please bear with me, I'm curious about a couple things.

Are some people genetically predisposed to developing blood clots? OR... If someone is on an anticoagulant or 'blood thinner' and still developing clots, what could cause that?

Once a clot has developed, I have been told by instructors, that the patient should remain in bed to prevent it from breaking off and ending up with a pulmonary embolism, the clot will eventually kinda disolve on its own. However, wouldnt the inactivity actually cause more clots to form? Especially in a person who already has some, and then you have them laying in bed, wouldn't they be even more susceptible for further complications? Or does the meds given in the hospital (heparin and coumadin) enough to keep more from forming?

Probably silly questions, I know, and forgive the spelling! But I do appreciate any input y'all can provide!

Thanks,

[joslina]

some people have factor V lieden witch is a clotting disorder and may need to have a filter placed in their groin to prevent clots from traveling to vital organs. in that case and others people could be on anticoag and still develop clots. if their inr is not theraputic or they are in afib and dont know or have taken a long trip and had legs dependent for a long period of time may be other reasons for clots to develop. being on coumadin/heparin/lovenox will prevent any future clots from developing (hopefully). your body has to dissolve the clots that are already developed

[SwansonRN]

I agree with everything the above poster has said Yes, some people are definitely genetically prone to forming blood clots and there are certain situations or states of health that put a person at risk as well like bedrest, smoking, pregnancy, etc. If someone is on an anticoagulant and they are still forming clots, it would important to make sure that the med they are using is working properly (by checking PT, PTT, or INR) and you'd also want to make sure they are taking it correctly. There are a bunch of foods, herbal supplements, and other meds that can interfere with those anticoagulants ability to work properly.

But it is also important to keep in mind that blood thinners aren't 100% effective either, especially in some diseases. So that might be another possibility.

You're right, bed rest for someone with a clot does seem counterproductive, but those individuals are put on prophylaxis measures based on the hospital's protocol to avoid further DVTs, although you would still want to assess for signs and symptoms. Remember when a pt has a DVT, preventing the untoward possibilities would be the #1 priority because those can be life threatening events!

[turnforthenurse, MSN, NP]

Also look at Virchow's Triad, which includes Hypercoagulability, Vessel Wall Damage (endothelial injury) and Stasis of blood flow. These are considered factors for developing a blood clot. Hypercoagulability could be due to some medications (such as birth control pills...there are many others) or certain disease states (cancers, nephrotic syndrome, trauma, burns, deficiency in antithrombin III). Pregnancy, smoking and obesity are also factors that contribute to hypercoagulability. Endothelial damage is anything that can damage the wall of the vessel (hypertension, the inflammatory response). Venous stasis is due to now forward flow of blood. If you think about it, A LOT of our patients are at risk for DVTs, which is why hospitals implement DVT protocols...typically the patient will receive Lovenox or Heparin and the physician will order SCDs and TED hose. If anticoagulation is contraindicated, such as in a patient with an allergy to an anticoagulant or if a patient is already bleeding from somewhere, typically only SCDs and TEDs will be ordered. As you mentioned, it does seem counterproductive to keep patients on bed rest with a DVT...but if a patient moves around, they could dislodge the clot that is already in their leg and it can go to their lung, causing a pulmonary embolus (PE) which is an even bigger problem.

[Esme12, ASN, BSN, RN]

moved for better response

[PunkBenRN]

I'm still in fundamentals so I know these questions probably seem pretty rudimentary or silly, but please bear with me, I'm curious about a couple things.

Are some people genetically predisposed to developing blood clots? OR... If someone is on an anticoagulant or 'blood thinner' and still developing clots, what could cause that?

See the other posts, they did a good job of describing these.

Once a clot has developed, I have been told by instructors, that the patient should remain in bed to prevent it from breaking off and ending up with a pulmonary embolism, the clot will eventually kinda disolve on its own. However, wouldnt the inactivity actually cause more clots to form? Especially in a person who already has some, and then you have them laying in bed, wouldn't they be even more susceptible for further complications? Or does the meds given in the hospital (heparin and coumadin) enough to keep more from forming?

The meds they give, generally heparin or lovenox (NEVER both) are to prevent further clotting. The body does all the work as far as dissolving the clot goes.