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   Hypercoagulability

NEWS, believes in the health concerns generated by hypercoagulability states in patients.  Once you have read the following article and thought about your own condition, entertain the idea that you too MAY be suffering from a coagulation problem.  At NEWS, we test for this condition through the Hemex Laboratories, directed by David Berg.  Please call our office for an appointment and we will be glad to discuss this possibility with you.
Hypercoagulability is the increased likely-hood of blood to become abnormally thick and thus increase the formation of fibrin-complexes in the blood vessels. 

Hypercoagulability causes a shift in haemostatic balance towards pro-clotting factors.  Most of us think of "clot formation" as the result of hypercoagulability [this is a cross-linking of fibrin caused by a burst of thrombin]...but more commonly the result is the deposition of fibrin [fibrinogen is the precursor of fibrin], obstructing blood flow and causing local ischemia [deficient blood flow] to involved areas.

When tissues don't receive sufficient blood, the cells are starved for oxygen and nutrients. Pain can result, as in headache or fibromyalgia.  Many chronic conditions such as attention deficit disorder, autism and schizophrenia, as well as multiple sclerosis, Parkinson's disease, irritable bowel, endocrine (hypothalamic-adrenal axis-related) sleep disorder, and the type of infertility that manifests itself in repeated miscarriages (fetal wastage syndrome), are all related to elevated blood viscosity and organ dysfunction caused by impeded, insufficient blood flow.

Hypercoagulability can occur after trauma, such as a severe infection, a car accident or severe emotional stress.  Most people eventually recover, but a minority go on to develop a chronic condition such as fibromyalgia. These individuals may be suffering from a genetic protein defect that makes them especially prone to develop the hypercoagulability state that then causes ischemia in tissues which then leads to chronic fatiguing pain.

According to Carol Ann Ryser, M.D., a pediatrician, every cancer patient in her clinical practice, in has been diagnosed with hypercoagulability. It appears that cancer cells produce a protein that acts as a pro-coagulant. Research confirms that cancer patients have an increased incidence of blood clots, and that low-dose heparin can be a useful adjunct therapy in cancer, increasing survival. Diabetics and AIDS patients also appear to benefit from low-dose heparin.

Hypercoagulability is also part of the inflammatory response. This association has not received the full attention it merits. We know that an excess tendency toward clotting is undesirable, and may indeed be fatal in the case of heart attacks and strokes. So far, however, not too much has been said about increased blood viscosity without actual clots, or about fibrin deposition inside blood vessels of individuals who suffer from chronic hypercoagulability.  Plaque formation may be due to inflammation that turns on the hypercoagulation which causes the plaque.  The inflammation may come from any where...viruses, bacteria, arthritis, bowel disease...anything that activates the inflammation cascades then activates a state of hypercoagulability.

Hypercoagulability is also promoted by:

bulletGenetic protein defect(s) [Protein C / Protein S
bulletHigh lipoprotein(a), by blocking fibrinolysis
bulletHigh homocysteine (over 10)
bulletHigh blood sugar
bulletHigh triglycerides
bulletEating polyunsaturated fatty acids that metabolize to Thromboxane, an eicosanoid derivative
bulletViruses
bulletBacteria
bulletChronic conditions that raise hsCRP

Altogether, the regulation of coagulation is quite complex, involving the balance of more than a dozen factors. It takes special tests to establish if a patient might be deficient in these proteins or shows elevated fibrinogen.

Hypercoagulability can be hinted at through the use of the well-known "sed-rate" blood test. A sed rate of less than 5 indicates hypercoagulability.   It is also suggested by having any of the following chemistry abnormalities:

bulletElevated Lp(a)
bulletElevated Homocysteine
bulletElevated hsCRP
bulletElevated Triglycerides
bulletElevated Fibrinogen.

The difficulty comes in trying to find out the major factor(s) causing the condition. Thus the need for additional testing, so that the right factor can be targeted for treatment.  Hemex Laboratories has specialized in testing for these coagulation defects as well as their causes.

Causes can be varied too but virus infections have been singled out as particularly likely to provoke excess fibrin production. This fibrin accumulates in certain places, creating a "fibrin block" that impedes blood flow and deprives a certain area of the body of sufficient oxygen. Dr. Ryser said that she finds a history of two to six serious infections per every chronic fatigue patient. There is also suspicion that certain vaccines can act as precipitating agents for inflammation-induced hypercoagulability (e.g. anthrax vaccine contaminated with mycoplasma, a suspect in the Gulf War Syndrome).

Hypercoagulability can be dramatically improved with the use of low-dose heparin (a natural anticoagulant, one of several produced by our own body).  Increasing blood flow can quickly clear up conditions such as inflammatory bowel syndrome, or help certain women avoid repeated miscarriage.

Glucosamine is a mild anticoagulant and one of its unexpected benefits is the prevention of migraines in people with mild hypercoagulability, at a dose as low as 1,500 mg/d or +3000mg/d. Using safe, mild, natural anticoagulants like glucosamine adds a useful new technique for migraine prevention.

The long-term safety of low-dose heparin administration requires further research; but for milder cases, and for prevention, we have access to safe hypocoagulant agents such as fish oil, curcumin (turmeric extract), ginger and ginkgo.

Many AntiAging physicians believe that hypercoagulability, like inflammation in general, is one of the characteristics of aging.  This acceptance of hypercoagulability represents a "paradigm shift" in our thinking about disease and aging.  Tissue atrophy, seen in aging persons, can be better understood as being caused by impeded blood flow leading to local ischemia (oxygen deficiency).  Only fifteen seconds of ischemia turns off the mitochondria. This initiates an apoptosis (programmed cell death) cascade. The shrinking of our organs with age leads to ever-greater pathology. Loss of heart tissue eventually results in congestive heart failure. Loss of glandular tissue results in hormone deficiencies, loss of neural tissue brings on cognitive dysfunction and eventually senile dementia, loss of lung tissue leads to emphysema, and so on. This is the atrophy of aging that we see throughout the body. The new insight is that "ischemia is a silent cause of aging and degenerative disease."

In order to fight ischemia, we need to keep the blood from getting too viscous and sluggish, and platelets from clumping too readily. We now see that various micronutrients are not only antioxidants, but also anticoagulants. Their great advantage is safety. We know how to counteract various procoagulant factors naturally: 

bulletHigh homocysteine, for instance, can be remedied through the use of folic acid, B12 and B6
bulletInhibit platelet aggregation through use of aspirin, curcumin, ginger and ginkgo  
bulletLower fibrinogen with curcumin 
bulletHigh lipoprotein(a) responds to niacin (or inositol hexanicotinate), high doses of vitamin C, and the amino acids lysine and proline. 
bulletMaintain a more youthful blood circulation through hormone replacement and exercise
bulletLower blood viscosity with enzymes such as bromelain and Wobenzyme 
bulletPromoting better circulation throught the release of tissue plasminogen activator (tPA) from the lining of blood vessels with massage 

Causes of aging in descending order are:

bulletStress = Age-related dysfunction of the hypothalamic-adrenal axis (HPA)
bulletHypothalamic-adrenal axis governs our neurohormonal response to stress
bulletOxidized adrenaline is a free radical
bulletInflammation
bulletHypercoagulability

Understanding hypercoagulability allows us to reach more patients with "strange syndromes" that don't seem to respond to any of our "drug" therapies.  Understanding hypercoagulability helps us anti-age....so that our "Golden Years" are golden.  Understanding hypercoagulability gets us closer to the reality of 21st Century Functional Medicine as it should be practiced. 

If you need help understanding hypercoagulability, please call our office for an appointment and we will be glad to discuss this possibility with you.

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Revised last: 1/2010