Behind many sudden deaths lie clots that block blood move to the center, lungs or mind. Globally, blood clots are linked to one in 4 deaths, which is greater than AIDS, breast most cancers and visitors accidents mixed.
In India, they have an inclination to strike earlier than in Western international locations, usually throughout folks’s most efficient years. Every yr, greater than 2.5 million Indians die from heart-related causes, with clotting a significant factor.
Yet the difficulty stays largely invisible in India’s public well being agenda. The warning indicators are simple to overlook: ache within the chest or extreme headache, swelling in a leg, or unexplained breathlessness or dizziness. Left untreated, this will result in sudden dying.
A stronger deal with prevention and early detection may flip the tide in opposition to this silent killer.
After viral infections, the danger of great clotting stays excessive. The Covid-19 pandemic revealed that infections could make blood extra vulnerable to clotting by damaging blood vessels, activating platelets – tiny cell fragments that assist type clots – and triggering irritation. During the pandemic, the D-dimer take a look at, which measures fragments of clots circulating within the blood, additionally turned broadly often known as a strategy to detect irregular clotting.
Public concern about clots has since light, however the risk persists. Dangerous clots are sometimes the hidden reason behind coronary heart assaults, strokes and blocked veins within the legs or lungs. These circumstances, collectively often known as venous thromboembolism, cowl two associated issues: deep vein thrombosis, when a clot varieties in a deep vein (usually within the leg), and pulmonary embolism, when that clot travels to the lungs. Both can recur, and trigger sudden dying or result in lasting organ injury.
Evidence means that vaccination helps shield in opposition to extreme sickness and lengthy Covid by sustaining immunity. However, uncommon circumstances of a situation referred to as thrombosis with thrombocytopenia syndrome – a mix of clotting and unusually low platelet counts – have been linked to the AstraZeneca and Johnson & Johnson vaccines, occurring in about 10 folks per million doses. mRNA-based vaccines from Pfizer and Moderna have not proven this impact.
Experts agree that the advantages of vaccination far outweigh the small danger of such uncommon unintended effects.
The danger of clotting rises amongst people who find themselves sedentary, overweight, diabetic, recovering from surgical procedure or trauma, or present process most cancers remedy. Women face added danger throughout being pregnant or whereas utilizing oral contraceptives, as hormone modifications could make blood thicker. Some households carry genetic mutations that make their blood extra more likely to clot.
Geography may play a task. Soldiers stationed at excessive altitudes in Siachen and Ladakh, and pilgrims trekking to Amarnath or Kailash Mansarovar, face circumstances resembling low oxygen, dehydration and excessive chilly that improve clotting danger.
Prevention and new cures
The excellent news is that prevention is straightforward: transfer extra, sit much less and keep hydrated. Standing or strolling each hour, even throughout lengthy flights or hospital stays, helps keep circulation. Those in danger ought to put on compression stockings, which gently squeeze the legs to stop blood from pooling, and seek the advice of their docs for early screening.
Treatment choices have additionally superior. Blood thinners or anticoagulants stay the principle line of defence. Older medicine resembling heparin (an injectable drugs) and warfarin (a pill that forestalls the liver from making clotting proteins) have lengthy been used to cease new clots from forming.
Newer oral anticoagulants act extra exactly on the physique’s clotting course of. Direct thrombin inhibitors resembling dabigatran block thrombin, the important thing enzyme that builds clots, whereas different inhibitors like rivaroxaban goal one other essential step.
India has made its personal mark on this discipline. The Council of Scientific and Industrial Research developed the clot-busting enzyme streptokinase, launched in 2009, which dissolves present clots. New recombinant, or laboratory-engineered, variations are actually being examined.
A subsequent era of medicine that block issue XI, one other clotting protein, may provide safer long-term choices. Global corporations together with Bayer, Novartis and China’s Jiangsu Hengrui are creating these therapies, now in medical trials.
Around the world, scientists are additionally engaged on quicker, extra correct diagnostic instruments. Handheld units resembling ClotChip and new urine-based exams can detect irregular clotting inside minutes. Indian researchers have created improvements such because the Indian Institute of Science’s nanozyme – a microscopic enzyme mimic that forestalls clots – and IIT (BHU)’s nanoparticles designed to ship anti-clot medicine instantly the place they’re wanted.
The Defence Research and Development Organisation (DRDO) has developed a diagnostic take a look at utilizing microRNA-145, a small molecule within the blood that helps regulate gene exercise and is linked to clot formation. This was later validated in Europe’s Trøndelag Health Study. Wearable ultrasound units and good biosensors may quickly make detection quicker, safer and extra accessible.
Because clot remedy may be costly and long-term, prevention stays far cheaper. Many circumstances come up throughout predictable hospital stays or most cancers remedy.
In 2008, the US Surgeon General made clot prevention a nationwide precedence, prompting hospitals to make use of checklists and discharge tips which have saved hundreds of lives. India has begun comparable efforts. The Indian Council of Medical Research launched the nation’s first hospital-based registry, i-RegVeD, in 2022, amassing real-time knowledge from 16 tertiary hospitals. Early outcomes from greater than 2,800 sufferers present excessive restoration charges and about 3% mortality.
The National Academy of Medical Sciences’ 2024 task-force report additionally recommends routine hospital danger checks to detect clots early. These initiatives may assist form nationwide coverage and make care extra evidence-based.
Despite sturdy public campaigns on diabetes and hypertension, consciousness of blood clots stays minimal. It is never talked about in colleges, workplaces and even in-flight security briefings, although easy consciousness may save hundreds of lives. A coordinated public marketing campaign by means of social media, airways, pilgrimage organisers and hospitals may make a vital distinction.
Clots may be deadly however are largely preventable. Early recognition, well timed medical care and sustained consciousness may also help India deal with this silent killer.
Mohammad Zahid Ashraf is Dean, Faculty of Life Sciences, Jamia Millia Islamia and a Fellow of all three of India’s National Science Academies.
Originally printed underneath Creative Commons by 360info™.
