Overview

When the body creates too many or too few blood clots, it can be because of a clotting disorder. A clotting disorder, or a coagulation disorder, can lead to:

• Hemorrhage – too little clotting that can lead to abnormal bleeding.
• Thrombosis – too much clotting that blocks blood flow to vital organs.

Both of these can cause serious health risks that a person should know more about.

Types

There are many different types of clotting disorders, though many of them are rare.

• Clotting disorders that cause too much bleeding:
  • Hemophilia: Blood that clots too slow, leading to excess bleeding.
  • Von Willebrand disease: This disorder causes excessive bleeding when the von Willebrand factor protein is low.
  • Liver disease: Various conditions can impair the liver and lead to a clotting disorder.
  • Vitamin K deficiency: This can impair proper clotting, leading to excess bleeding.
  • Platelet dysfunction: Platelets are necessary to make clots. If these are low or not working, the blood will not clot the way it should.
  • Disseminated intravascular coagulation: Overactive clotting that leads to obstructions in the blood vessels.
  • Overdevelopment of circulating anticoagulants: Lessened clotting creates a condition that has symptoms similar to hemophilia.
  • Other clotting factor deficiencies: Clotting factor protein levels that are low can result in excessive bleeding.
• Clotting disorders that cause too much clotting:
  • Factor V Leiden: The factor V Leiden protein overreacts. This causes blood to clot too often.
  • Antithrombin III (ATIII) deficiency: Low levels cause too much clotting.
  • Protein C or Protein S deficiency: Proteins that help regulate bleeding and clotting. Low levels of either cause too much clotting.
  • Prothrombin (PT) gene mutation or factor II mutation: This causes too much clotting factor to be made.
  • Antiphospholipid antibody syndrome: An autoimmune disorder that increases some blood proteins increasing the risk of clotting.

Causes

A clotting disorder is either inherited or acquired. If it is inherited, it is passed down from a parent through genetics. These are mutations in the genes that cause the body to make mistakes when it forms blood clots. Acquired clotting disorders are those that come after disease, trauma, medicine or some other risk factor presents itself in the body and causes it to make mistakes in forming clots.

Some risk factors for clotting disorders are:

• Age: Newborns with a deficiency in vitamin K or older adults with hemophilia A, for example.
• Family history
• Being a male
• Certain medical conditions: Cancer, autoimmune diseases, or liver disease (examples)
• Blood transfusions
• Obesity
• Infections
• Hormone-based medications like birth control or hormone replacement therapy
• Surgery
• Certain medications: Some antibiotics, anticoagulants, interferon Alfa (examples)
• Pregnancy and giving birth
• Being inactive and sitting for long periods
• Medical devices that help to increase blood flow

Symptoms

Clotting disorders can have a wide range of symptoms, depending on the type of disorder, what the cause of it is and how serious it has become. Some people may not show signs or symptoms until a major medical event occurs in their life.

Some of the main symptoms of excessive bleeding can include:

• Blood in urine or stool.
• Excessive bleeding: This is bleeding that will not stop when pressure is applied. It may start spontaneously.
• Large, frequent bruises.
• Heavy bleeding after giving birth.
• Heavy menstrual bleeding: This also includes menstrual bleeding that lasts longer than seven days or bleeding that requires a change of pad or tampon more than once an hour.
• Petechiae: Bleeding under the skin causes tiny purple, brown or red spots.
• Pain, stiffness, redness, or swelling in the muscles or joints from bleeding.
• Umbilical stump bleeding that lasts longer than normal – 1 to 2 weeks after being cut or that does not stop.

Treatment

Treatments for clotting disorders can vary depending on the type of clotting disorder someone has.

• Clotting disorders that cause too much bleeding:
  • Replacement therapy: an injection to replace the low or missing clotting factors.
  • Immunosuppressant therapy or Porcine factor therapy.
  • Medications: Pills, injections, or topicals such as thrombin gel or fibrin glue.
• Clotting disorders that cause too much clotting: The best treatment is to give the person an anticoagulant, or antiplatelet medication. The method of administration for these can be IV, intramuscular injection, or orally in pill form.

Medications

The medications for a clotting disorder are varied in many ways. There is no “one size fits all” for these disorders. It will depend on the patient, the type of disorder, and sometimes even the doctor who is prescribing it.

Anticoagulants

Anticoagulants are commonly known as blood thinners. They slow down the body’s process of making blood clots. Some of the most common anticoagulants are:

• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)
• Rivaroxaban (Xarelto)
• Warfarin (Coumadin)

Antiplatelets

Antiplatelets are medicines that prevent platelets from clumping together and forming a clot. These are used primarily by people who have had a stroke or a heart attack. Some of those include:

• ASA, also called acetylsalicylic acid (Aspirin, Asaphen, Entrophen, Novasen)
• Clopidogrel (Plavix)
• Prasugrel (Effient)
• Ticagrelor (Brilinta)

Hemophilia

This disorder is complex and it is important to have a doctor who is knowledgeable about it. A team of specialists, including a hematologist, social worker, nurse, and other healthcare professionals can help care for an individual with hemophilia.

Some of the medications that may be given are:

• Clotting Factor Proteins:
  • Plasma-derived factor concentrates
  • Recombinant factor concentrates
• Hemlibra (ACE 910 or emicizumab)
• DDAVP or Stimate (Desmopressin Acetate)
• Amicar (Epsilon Amino Caproic Acid)
• Cryoprecipitate

Von Willebrand Disease

Some medicines can help treat or prevent bleeding episodes in those with von Willebrand disease. These include:

• Desmopressin
• Replacement therapies
• Oral contraceptives
• Clot-stabilizing medications:
  • Aminocaproic acid (Amicar)
  • Tranexamic acid (Cyklokapron, Lysteda)
• Topical medicines applied to cuts such as Tisseel