Thrombosis

The Montefiore Einstein Hematology (Blood Disorders) Division is at the forefront of innovation, research and clinical care for all types of blood disorders. Our Hematology (Blood Disorders) Division boasts two distinct but interactive programs centering on patients with bleeding and thrombotic (clotting) disorders: The Thrombosis Prevention and Treatment Program (Thrombosis Program) and The Adult Comprehensive Hemostasis and Thrombosis Center (HTC).

The Thrombosis Prevention and Treatment Program was among the first in the country to manage bridging parenteral anticoagulation as outpatient therapy. Now, with newer and more effective oral anticoagulants, our Thrombosis Program concentrates on managing patients with complex thrombotic diseases and delivering their expertise directly to the patients. Every patient is unique, with their own medical histories, on their own set of medications and with their own social situations. Our dedicated providers will develop a highly personalized treatment plan for you and they will work with you to find the best therapies that will work for your unique health needs. With clinics at both the Moses Campus and the Jack D. Weiler Hospital, Einstein Campus and clinics almost daily, we can accommodate your scheduling needs. In addition, we specialize in tele-visits so that you can talk to your thrombosis provider from work, home or school.

Montefiore Einstein offers the following content from the health information library of the National Institutes of Health’s National Library of Medicine and the National Heart, Lung and Blood Institute.

What Is a Thrombosis?

A thrombosis (or blood clot) is a mass of blood that forms when platelets, proteins and cells in the blood stick together. When you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body breaks down and removes the blood clot so the blood can flow more freely again through your blood vessels. Blood clotting disorders are problems in the body’s ability to control how the blood clots. Normally, blood clots form during an injury to prevent bleeding. If you have a clotting disorder, your blood may not clot enough, which can lead to too much bleeding, or your blood may form clots even without an injury. Sometimes the blood clots form where they shouldn’t, your body makes too many blood clots or abnormal blood clots, or the blood clots don’t break down like they should. These blood clots can be dangerous and may cause health problems.

Types of Thrombosis

Blood clots can form in, or travel to, the blood vessels in the limbs, lungs, brain, heart and kidneys. The types of problems blood clots can cause will depend on where they are and whether they occur in the arteries or the veins.

  • Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in the lower leg, thigh or pelvis. It can block a vein and cause damage to your leg.
  • A pulmonary embolism (PE) can happen when a DVT breaks off and travels through the bloodstream to the lungs. A PE, especially if it is large, can damage your lungs and prevent your other organs from getting enough oxygen.
  • Cerebral venous sinus thrombosis (CVST) is a rare blood clot in the venous sinuses in your brain. Normally the venous sinuses drain blood from your brain. CVST blocks the blood from draining and can cause a stroke.
  • Arterial blood clots can cause problems such as an ischemic stroke, a heart attack and kidney problems.

Blood clotting disorders are sometimes called thrombophilias. They are either inherited or acquired.

  • “Inherited” means that your parents passed the gene for the disease on to you. Mutations, or changes in certain genes, can make your blood more likely to form clots. Some genetic changes are more common than others. The more common genetic changes are not as likely to cause serious blood clots as the rarer genetic changes.
  • “Acquired” means that you weren’t born with the disease, but you developed it due to another disease or condition. Pregnancy, surgery and certain medications can predispose you to clots.

Just because you have a blood clotting disorder does not mean that you will develop blood clots. But it does increase your chance of having blood clots throughout your lifetime.

Inherited blood clotting disorders

  • Common inherited blood clotting disorders include:
    • Factor V Leiden mutation, which occurs in 5% of people of European descent
    • Prothrombin G20210A mutation (also called factor II mutation), which occurs in 2% of the population
  • Rare inherited blood clotting disorders include:
    • Deficiencies in blood clotting proteins called protein C, protein S and antithrombin
    • Hyperhomocysteinemia

Acquired blood clotting disorders

  • Examples of acquired blood clotting disorders include:
    • Antiphospholipid syndrome (APS): This is the most common acquired clotting disorder. APS is an autoimmune condition where the body makes antibodies that mistakenly attack cell molecules called phospholipids. Higher levels of APS antibodies in the blood raise the risk of blood clots.
    • Disseminated intravascular coagulation (DIC): This condition is caused by an infection (such as sepsis) or an injury.

Causes of Thrombosis

Certain factors can raise your risk of developing blood clots:

  • Atherosclerosis
  • Atrial fibrillation
  • Being overweight or having obesity
  • Cancer and cancer treatments
  • Certain genetic disorders
  • Certain surgeries
  • COVID-19
  • Diabetes
  • Family history of blood clots
  • Overweight and obesity
  • Pregnancy and giving birth
  • Serious injuries
  • Some medicines, including birth control pills
  • Smoking
  • Staying in one position for a long time, such as being in the hospital or taking a very long car or plane ride

Signs & Symptoms of Thrombosis

Most clots occur in the legs and patients may experience sudden or gradual pain, swelling, tenderness and warmth in one or both legs. But the symptoms for blood clots can be different, depending on where the blood clot is. In the lungs, patients may feel short of breath, or have pain with deep breathing. They may be breathing quickly and have an increased heart rate. In the brain, they may develop trouble speaking, vision problems, seizures, weakness on one side of the body, or have a sudden severe headache.

Treating Thrombosis

Some people with blood clotting disorders may never get blood clots and may not need treatment. Your previous history of blood clots as well as your current risk factors may be considered to decide a treatment plan.

Treatments for blood clots depend on where the blood clot is located and how severe it is. Treatments may include:

  • Blood thinners like apixaban, rivaroxaban, dabigatran, warfarin, aspirin
  • Thrombolytics. These are medicines that dissolve blood clots. They are usually used only when the blood clots are severe since they can cause bleeding.
  • Surgery and other procedures to remove the blood clots (thrombectomy)

The Montefiore Einstein Thrombosis Prevention and Treatment Program provides a comprehensive thrombophilia (hypercoagulability or increased tendency for thrombosis) service, has dedicated Anticoagulation Clinics, and facilitates outpatient treatment for individuals with acute thrombotic disease. It will work with you to decide which therapy is right for you.

Preventing Thrombosis

You may be able to help prevent blood clots by:

  • Moving around as soon as possible after having been confined to your bed, such as after surgery, illness or injury
  • Getting up and moving around every few hours when you have to sit for long periods of time, for example if you are on a long flight or car trip
  • Wearing compression stockings after surgery or during a long flight
  • Regular physical activity
  • Not smoking
  • Staying at a healthy weight

Some people at high risk may need to take blood thinners to prevent blood clots.