I will never forget something that happened one afternoon about 12 years ago. A woman came to see me, and with tears in her eyes in a trembling voice said, “My son just died, and I need some help.”
It was very sad. Her 26-year-old son was in the hospital for appendicitis. The doctors successfully removed the infected appendix and presumably all was well. The next day he suddenly died from a blood clot.
The clot had silently formed in his legs in the immediate hours after the surgery. Then a piece of it broke off and travelled to his lungs and killed him. All without any warning. This perfectly healthy young man died from a preventable problem.
And here’s the scary thing. It could happen to anyone. Why wasn’t it prevented? And what can you do to protect yourself if you need surgery?
Each year somewhere between 50,000 and 200,000 people die from the same kind of blood clots that killed this young man. The medical term for clots that travel to the lungs is pulmonary embolism. It happens commonly.
I frequently have patients who have emergency surgery and end up with a pulmonary embolism. Fortunately, the doctors usually catch it early enough and they are fine. But that’s not always the case.
About 30% of the time people die from a pulmonary embolism before anyone can diagnose and treat the problem. If you are in a hospital, no matter what you are in there for, you have a one in a hundred chance of dying from a pulmonary embolism.
There Are Three Factors That Cause These Killer Clots
First, most people are in a hospital for conditions that cause inflammation. Surgery is a significant cause of inflammation. So is any infection. Inflammation causes clots to form.
The second reason is being bedridden. Lack of walking leads to a stagnation of the blood in the legs. This increases the chance of clotting. That explains why the most likely surgeries to cause clots are those involving the pelvis, hips, and legs. And it is also why surgeons are so insistent in getting people to walk soon after surgery.
And third, there’s an inherited tendency for certain people to form clots. This condition is referred to as hypercoagulability. It means an excessive tendency to form a clot. This is the major reason that this young man and most people die from blood clots. They have a genetically inherited tendency toward hypercoagulability.
When you cut or injure yourself, the body stops the bleeding by forming a blood clot. This process is called coagulation. It’s a very complex and delicately balanced process. If there is a lot of bleeding, there needs to be a lot of coagulation.
On the other hand, if there is no bleeding there should be no coagulation. Hypercoagulability is when the coagulation process tends to form clots when there is no bleeding. And it explains why certain people will form dangerous blood clots after surgery and others won’t.
Wouldn’t it be great to know if you had a tendency toward hypercoagulability before you had surgery instead of finding out the hard way later on? Fortunately, there is a way to do just that.
How to Know if You’re Safe
The most common genetic tendency to hypercoagulability is an abnormal gene called factor 5 Leiden. Close to 30% of the time someone gets a blood clot it’s because they have factor 5 Leiden. About 5% of Caucasians have factor 5 Leiden. It is much less common in Hispanics and African-Americans. And it’s extremely rare in Asians.
The second most common cause of hypercoagulability is the female hormone estradiol. There are two ways that estradiol can cause hypercoagulability. One is when a woman takes too much estradiol as part of a hormone replacement program. Even bio-identical estradiol can be a problem if the dose is too high.
The other is when the woman does not have enough progesterone. Progesterone offsets the tendency to hypercoagulability that estradiol causes. Every woman taking estradiol as part of her bio-identical hormone replacement must have the right amount of progesterone to balance it out. The ratio between the two is very important, and you should have it checked. But men also need to be concerned about estradiol.
Men make estradiol. But this is not a problem for men who have an adequate amount of testosterone. Testosterone offsets the clotting effect of estradiol in men just like progesterone does in women. But as men get older, their bodies tend to convert their testosterone into estradiol. This is especially true if they drink too much or are overweight. And this switch in hormone balance can cause hypercoagulability. As a rule, the ratio of testosterone to estradiol should be about 1:20. Greater than that could increase hypercoagulability. This is one reason why it is so important to check estradiol levels in men who are getting testosterone replacement.
There’s a Twist to This Story
Having a factor 5 Leiden makes the blood even more sensitive to the hypercoagulable effects of estradiol. That’s why it makes good sense to run a factor 5 Leiden test on anyone having surgery, and any man or woman receiving bio-identical hormone replacement.
If the test is positive in a woman, it is especially important to keep the estradiol dose as low as possible. It’s also equally important to make sure that the testosterone-to-estradiol ratio in the blood of men with a positive factor 5 Leiden is at least 20. Anything less might result in hypercoagulability.
But these aren’t the only risk factors that cause hypercoagulability. Others are less common, but still important. They are:
• Prothrombin gene mutation (G20210A). Next to factor 5 Leiden this is the most common genetic reason for hypercoagulability.
• Deficiencies of antithrombin, protein C, and protein S. These are proteins that prevent clotting.
• Elevated levels of homocysteine.
• Elevated levels of fibrinogen.
• Elevation in levels of plasminogen activator inhibitor (PAI-1).
What You Should Do
So here’s what I wish would happen for everyone anticipating surgery, especially those who are Caucasian, have a family history of blood clots, or are on hormone replacement therapy.
Have your doctor run the following tests:
• fibrinogen level
• factor V Leiden
• prothrombin gene mutation (G20210A)
• PAI-1 activity
• antithrombin activity
• protein C activity
• protein S activity
• fasting plasma homocysteine.
If these tests are all negative, there’s not much chance that you will have a blood clotting problem. If one of them is abnormal, then your doctor can take the necessary measures to keep your blood thin after surgery. If these tests were taken routinely before surgery, we could save between 50,000-200,000 lives a year.
There’s one other factor to consider. If none of the coagulation tests are positive, but you are either going to have surgery or are confined to bed for any reason. Just to be safe, I recommend the following.
First, take a curcumin extract. Take one tablet two times per day. Curcumin is very effective at decreasing the inflammation that can cause clots.
Next, take 100 mg of nattokinase twice a day. I have written about nattokinase before. It’s an enzyme that comes from a fermented food called natto, which has been popular in Japan for over 1,000 years. Nattokinase is able to dissolve the fibrin that forms clots.
We already have something that naturally occurs in our blood that dissolves blood clots. It’s called plasmin. Studies show that nattokinase has four times more clot-busting power than our own plasmin.
You can take both curcumin and nattokinase before surgery because they won’t increase the risk of bleeding. The next two supplements should be started as soon as possible after surgery.
Next, take a full dose of gingko biloba. Gingko helps to protect the blood from an excessive tendency to clot. You can find gingko at any health food store and online.
Finally, take two fish oil capsules a day. Fish oil contains the fats EPA and DHA. The membranes of platelets take these up and they prevent the platelets from sticking together and forming clots.
So the idea is that curcumin, gingko, and fish oil act to prevent clots. And if a small clot somehow happens anyway, nattokinase should dissolve it before it can cause a problem.
Rahimtoola, A. and J.D. Bergin. “Acute pulmonary embolism: an update on diagnosis and management.” Current Problems in Cardiology, 30 (2): 61–114.