Is Clotting the Problem?

I’ve been wondering about clotting recently. First some background for context. As you may know, I was super-fit, super healthy and the last person on Earth that anyone expected to have any heart issues. Despite that I had a major heart attack earlier this year and have been recovering since.

As is often the case, it is impossible to determine the exact cause, but the heart attack itself was due to a 100% blockage in my Right Coronary Artery. The blockage was a large clot that was removed as part of an angioplasty procedure where two stents were inserted. The angiogram taken during that procedure showed that other than the clot itself all of my coronary arteries were clear of any plaque build up.

The general medical consensus was that I was just unlucky and with a family history of heart issues these things sometimes happen, even to someone relatively young. There was mention of things such as too much training leading to a slightly enlarged heart or maybe the fact that I was just particularly good at clotting but again no definitive answer as to ‘why me’ was ever given.

Family History

There is indeed a family history of heart issues, especially on my Dads side. That said, my Dad’s side of our family is one of (if not the) largest families in the UK. If we just look at it from a numbers point of view then it stands to reason that some of those people will have had heart issues.

According to the British Heart Foundation:

• Heart and circulatory diseases cause a quarter of all deaths in the UK, that’s more than 160,000 deaths each year – an average of 460 deaths each day or one every three minutes in the UK.
• There are around 7.6 million people living with a heart or circulatory disease in the UK: 4 million men and 3.6 million women.

7.6 million people with heart or circulatory disease is more than 10% of the UK population. I haven’t done the maths as I don’t know our full family history or the total numbers in our family. However, if the number of people in the family who had had heart issues is around 10% then maybe it’s not a ‘bad family history’ after all, it might just be normal but looks bad due to the number of people involved. I’m also not sure of the ages of the people in the family who have had heart issues – most of them seem to keep going until they are pretty old, so maybe the family history isn’t as bad as we first think.

Clotting Issues

In my immediate family, which I know more about, my Dad has had a number of TIA’s which have as far as I know been induced by clots. My younger Brother also had a full blown stroke in his early 40’s, again caused by a clot. I don’t know if the heart issues that family on my Dad’s side have had were caused by clots, but we can assume at least some of them were. I have also heard reports of various people from my Dad’s side of the family having had clots in a number of other places too. Clots in the lungs, eyes, arms and legs to name a few.

I’m beginning to think that maybe the ‘bad’ family history (if it is actually ‘bad’) is one of issues with clotting rather than heart issues. Yes, in some cases, such as mine, the clots lead to heart problems, but maybe the real cause is the clotting.

Clotting Disorders

There are a whole host of clotting disorders that people can suffer from. Some of these are inherited, genetic conditions. As with all medical conditions the diagnosis and treatment varies depending on the exact nature. There are various tests that can be performed to help with diagnosis. As far as I know, no one in our family has ever been tested for such things.

You know what that means don’t you? Time for me to do some research, find out what the various tests entail and then speak to my GP or cardiologist to find out what we can do. The tests might do no more than rule out these clotting disorders as an issue, but you never know, they may just pick something up. If they do and there’s something that can be done to control it then that’ll be good.

Anti-Clotting Drugs

I’m currently on Ticagrelor, a drug that slows the blood’s clotting action by making platelets less sticky. This is prescribed as a matter of course following the insertion of stents and is prescribed for a period of a year after the angioplasty. That means I’ll be due to stop this drug in June. I will of course be consulting my cardiologist about this before it stops. I’ll be highlighting my observations above about clotting in the family and asking if, in light of this stopping the Ticagrelor is a good idea. I’ll also be asking about the implications of staying on it long term and how we can monitor my clotting ability if we do stop it.

Personalised Approach

Sometimes the procedures that the NHS follows do seem to be a one-size fits all approach. I’ve had a heart attack, I’ve had stents fitted, so I’m on the same cocktail of drugs as everyone else who has been through the same procedure.

That approach gets us back on track and works for the majority of people in my situation. The majority of people in my situation were also unfit, overweight, elderly, smokers or had some other underlying issues that led to a heart attack in the first place. Many have a combination of the prior risks. I can see why the NHS provide the same treatment for everyone, they don’t have the resources to fully investigate every case, especially when the majority of them will have the same outcomes.

I’m not convinced however that the treatment should be the same for everyone. Some people are outliers and these should be investigated more fully. Sometimes I feel as though it needs to be a more personalised service. I had none of these risk factors, so maybe the underlying cause was a little different to the majority? If so, maybe there should be more investigations into the actual cause. This might have findings that mean that maybe the treatment could be adjusted accordingly. Who knows, if it highlights an underlying genetic clotting issue then it might be a helpful diagnosis for everyone in the family.

Lots to think about, lots of questions to answer, but maybe clotting is the issue. It’s an avenue that’s worth exploring if nothing else.

Tags: HealthHeart Attack