Coagulation disorders

General: Treatment varies depending on the specific type and severity of the coagulation disorder. Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.

Anticoagulants: Anticoagulants, such as warfarin (Coumadin®), enoxaparin (lovenox®), or heparin, are used to prevent blood clots from forming. These drugs are commonly called blood-thinners. Patients typically receive a combination of warfarin and heparin when they are first diagnosed with a blood clotting disorder. Then, depending on the specific condition, warfarin may need to be taken for the rest of the patient's life. Enoxaparin is commonly used to prevent deep vein thrombosis (DVT) in patients who are on bed rest.

Anti-platelet drugs: Anti-platelet drugs, also called platelet aggregation inhibitors, have been used to prevent platelets from forming clots. Examples include aspirin, clopidogrel (Plavix®), and cilostazol (Pletal®).

Clotting factors: Hemophiliacs may receive injections with clotting factors, either taken from donated human blood or produced in a laboratory using recombinant technology. This helps the body clot properly. Some patients may require repeated infusions if the internal bleeding is severe. Some healthcare providers may recommend preventative treatment with injections of clotting factors to help avoid future bleeding episodes.

Blood transfusions: Patients who suffer from severe bleeding may receive blood transfusions with donated blood. This helps restore the lost blood.

Patients with severe cases of thrombocytopenia may receive platelet concentrates.

Plasmapheresis: Thrombotic thrombocytopenic purpura (TTP) requires emergency treatment with plasmapheresis. During plasmapheresis, plasma (which contains platelets) from a blood donor is transfused into the TTP patient's blood. Plasmapheresis is continued until the platelet count normalizes and there is minimal breakdown of red blood cells (hemolysis).

Corticosteroids and/or immunosuppressants: Patients with mild idiopathic thrombocytopenic purpura usually do not require treatment. Patients who have moderate to severe cases typically receive medications that block the antibodies that attack platelets, such as corticosteroids (like prednisone), or medications that suppress the immune system to reduce antibody formation, such as cyclophosphamide (Cytoxan®) or azathioprine (Imuran®). Treatment is generally continued for the rest of the patient's life.

Desmopressin: Patients who have coagulation disorders that cause increased bleeding may receive a slow injection of the hormone desmopressin (DDAVP). This hormone stimulates the body to release clotting factors to stop bleeding. Sometimes desmopressin is given as a nasal spray.

Vitamin K: Low levels of vitamin K may lead to increased bleeding, especially in infants. That is why newborns typically receive injections of vitamin K shortly after birth. Vitamin K is found in green leafy vegetables, such as spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Patients should talk to their healthcare providers and/or pharmacists before taking vitamin K supplements.

Patients who are already receiving coagulation therapy should not drastically change their eating habits unless they consult their healthcare providers first. Significant changes in vitamin K consumption may have an impact on the effectiveness of treatment.

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Policosanol: Policosanol is a natural product made from the waxy coating of sugar cane that helps lower cholesterol. Various studies have investigated the effect of policosanol on platelet aggregation. In general, studies suggest that policosanol inhibits platelet aggregation caused by collagen and arachidonic acid.

Avoid if allergic or hypersensitive to policosanol. Use cautiously with nitrates, aspirin, or drugs that lower cholesterol or blood pressure. Avoid if pregnant or breastfeeding.

Vitamin K: Vitamin K is found in green leafy vegetables, such as spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Vitamin K deficiency in infants may lead to hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding (VKDB). Although almost half of newborns may have some degree of vitamin K deficiency, serious hemorrhagic disease is rare. Because vitamin K given by injection has been shown to prevent VKBD in newborns and young infants, the American Academy of Pediatrics recommends administering a single intramuscular injection of vitamin K1 to all newborns. Oral dosing is not considered adequate as prevention, particularly in breastfeeding infants. Initial concerns of cancer risk were never proven and are generally not considered clinically relevant. In cases of true VKDB, bleeding may occur at injection sites, at the umbilicus, or in the gastrointestinal tract. Life-threatening bleeding into the head (intracranial) or in the area behind the lower abdomen (retroperitoneum) may also occur. Evaluation by a physician is imperative.

Warfarin (Coumadin®) is a blood-thinning drug that inhibits vitamin K-dependent clotting factors. Warfarin is prescribed by doctors for people with various conditions, such as arterial fibrillation, artificial heart valves, history of serious blood clot, clotting disorders (hypercoagulability), or placement of indwelling catheters/ports. Usually, blood tests are done regularly to evaluate the extent of blood thinning, using a test for prothrombin time (PT) or International Normalized ratio (INR). The range for the PT/INR depends on the condition being treated. The PT/INR can become elevated for many reasons and sometimes can be dangerously high and increase the risk of serious bleeding. Patients taking warfarin should be aware of these potential causes, which include many drugs that interact with warfarin, liver disorders, or accidental warfarin overdose. Because the effects of warfarin on anticoagulation are usually delayed several days, the PT/INR may not increase immediately at the time of overdose. If a person's blood becomes too "thin," treatment should be under strict medical supervision and may include oral or injected vitamin K to help reverse the effects of warfarin.

Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional. Many serious side effects have occurred after injection. Menadiol, a type of vitamin K that is not available in the United States, should be avoided with glucose-6-phosphate dehydrogenase deficiency. Avoid if pregnant. Large amounts of vitamin K may cause serious side effects or death. Vitamin K is generally considered safe for breastfeeding mothers.

Unclear or conflicting scientific evidence :

Aortic acid: Aortic extract is usually made from the hearts of animals, usually sheep, cows, or pigs. There are many substances in this extract, including aortic acid, which is a broad term encompassing several constituents. Mesoglycan is the most studied of these constituents. Further research is needed to determine whether or not aortic acid may help treat patients with deep vein thrombosis (DVT).

There are currently no reports of allergic reactions available. Due to the heparin sulfate content of mesoglycan, patients with an allergy to heparin or heparinoid derivatives should use aortic acid cautiously. Use cautiously with coagulation disorders or if taking anticoagulation therapy. Use cautiously with high blood pressure or if taking drugs that lower blood pressure. Avoid if pregnant or breastfeeding.

Garlic: The Garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. Garlic, which is often used as a spice in food, has also been used to treat many medical conditions. Garlic has been studied in humans as a possible anticoagulant therapy. Because garlic has been associated with several cases of bleeding, therapy should be used cautiously, especially in patients who are taking other medications, herbs, or supplements that may increase the risk of bleeding.

Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures to avoid bleeding problems. Avoid supplemental doses if pregnant or breastfeeding.

Ginger: The underground stems (rhizomes) and above ground stems of ginger have been used in Chinese, Japanese, and Indian medicine for hundreds of years. One study suggests that ginger may increase the effects of the anti-platelet medication nifedipine in patients who have high blood pressure. Further research is necessary to determine if ginger might be used as an anticoagulant therapy.

Avoid if allergic to ginger or other members of the Zingiberaceaefamily, including red ginger, Alpinia purpurata, shell ginger, Alpinia zeru, green cardamom, or Balsam of Peru. Use cautiously if driving or operating machinery because ginger may cause drowsiness. Stop two weeks before and immediately after surgery/dental/diagnostic procedures due to risk of bleeding. Avoid with a history of irregular heartbeat (arrhythmia). Use cautiously with a history of ulcers, acid reflux, heart conditions, inflammatory bowel disease, blocked intestines, or bleeding disorders. Use cautiously if pregnant or breastfeeding.

Pycnogenol: Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster ssp. atlantica), which is grown in coastal southwestern France. Pycnogenol® contains oligomeric proanthocyanidins (OPCs), as well as several other bioflavonoids: catechin, epicatechin, phenolic fruit acids (such as ferulic acid and caffeic acid), and taxifolin. According to the results of one human study, Pycnogenol® may reduce platelet aggregation in smokers. However, further research is needed before a firm conclusion can be made.

Pycnogenol® treatment may effectively decrease the number of thrombotic events (deep vein thrombosis and superficial vein thrombosis) in moderate- to high-risk subjects, during long-haul flights. Edema (swelling) may also be reduced. Further research is needed to confirm these results.

Avoid if allergic or hypersensitive to Pycnogenol®, its components, or members of the Pinaceae family. Use cautiously with diabetes, hypoglycemia, bleeding disorders. Use cautiously if taking hypolipidemic agents (drugs that lower cholesterol), medications that may increase the risk of bleeding, hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.

Rutin: Rutin is a yellow crystalline flavonol glycoside that occurs in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. Superficial vein thrombosis (SVT) is a common complication of varicose veins. One clinical trial suggests that a rutin-containing drug called Venoruton®, in combination with elastic compression or thrombectomy, offers benefit as compared to these treatments alone. Additional study is needed in this area.

Avoid if allergic or hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco, or buckwheat. Use cautiously in elderly patients. Use cautiously with skin conditions. Use cautiously if taking medications for edema, diuretics, or anticoagulation medications (e.g. heparin or warfarin). Use cautiously if pregnant or breastfeeding.

Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory study has found anticoagulant properties in fucans or fucoidans, which are components of brown algae such as bladderwrack. However, there are no high quality human studies available to support this use.

Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.

TENS (transcutaneous electrical nerve stimulation): TENS (transcutaneous electrical nerve stimulation) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS has been suggested as a possible treatment for skin flap ischemia. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures, such as breast reconstruction. Currently, there is not enough reliable evidence to draw a firm conclusion in this area.

Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as a nerve disorder called neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.

Yohimbe bark extract: The terms yohimbine, yohimbine hydrochloride, and yohimbe bark extract are all related. However, they all have slightly different meanings. Yohimbine is found in the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. Pre-clinical studies report that yohimbine alkaloid, a constituent of yohimbe bark, may inhibit platelet aggregation. Research in humans is limited, and more research is necessary in this area.

Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or any ingredients in yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease, or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or in pregnant or breastfeeding women.

Fair negative scientific evidence :

Boron: Boron is an element that is found around the world. It has elements that border between metals and non-metals. Boron can enter the body through the skin, lungs, or mouth. It has been proposed that boron may affect the activity of certain blood clotting factors. However, the study results are conflicting. There is not enough evidence in this area to form a clear conclusion.

Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions, such as breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.

General: Some types of coagulation disorders, such as those that are inherited, cannot be prevented. However, individuals can take steps to reduce their risks of developing blood clots or excessive bleeding that can be caused or made worse by certain lifestyle or nutritional habits.

Exercise: Regular exercise may help reduce the risk of blood clots. This is because sitting still for extended periods of time may slow blood flow, causing blood to accumulate in the veins, especially in patients who are at risk of developing blood clots.

Patients who are paralyzed or on bed rest after surgery should talk to their healthcare providers about recommended exercises. A physical therapist may be recommended to improve mobility in patients who are injured or suffer from disabilities.

Patients who are sitting on airplanes for several hours should stand up and stretch every hour. If possible, walk up and down the aisle a few times during a flight to increase blood flow. Patients on long car, bus, or train trips are likewise advised to get up every couple of hours and stretch their legs. Avoid crossing the legs because that may increase the pressure on the blood vessels.

Weight control: Weight control may help prevent blood clots from forming. Obese patients are more likely to develop blood clots because the extra weight puts pressure on the veins and reduces blood flow.

Vitamin K: Low levels of vitamin K in the blood may lead to an increased risk of bleeding. Therefore, patients should consume a healthy and balanced diet that is rich in vitamin K. Vitamin K is found in green leafy vegetables like spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Newborns should receive an injection of vitamin K shortly after birth to avoid bleeding problems. Patients should consult their healthcare providers before taking vitamin K supplements.

Patients who are already receiving coagulation therapy should not drastically change their eating habits unless they consult their healthcare providers first. Significant changes in vitamin K consumption may have an impact on the effectiveness of treatment.