Medication adherence, compliance key to battling blood clots–experts

In 2019, Ramonito Saturno was on his way back to the Philippines from Jeddah when the person seated next to him inside the airplane noticed that he was “restless.”

When the plane landed, Saturno was immediately rushed to the airport clinic before he was transferred to a hospital for surgery.

Dr. Bimbo Diaz of the Philippine Society of Hypertension (PSH), Saturno’s physician, recalled that an emergency surgery had to be performed after the patient suffered a “malignant stroke.”

Saturno, 56, is a stroke survivor and is already making a full recovery.

Nakakakilos na ako, tumutulong sa paglinis ng bahay, paghugas ng pinggan [Now I can move, help clean the house, and wash the dishes],” Saturno said during the Menarini Asia-Pacific virtual media forum on thrombosis, or blood clots, over the weekend. This effort is in line with company’s initiative to raise awareness among people who are affected by blood clots or who are at increased risk of getting them.

 Dr. Marcellus Ramirez of the Philippine Heart Rhythm Society led the discussion on thrombosis and atrial fibrillation—two factors that need to be considered to detect and prevent the risk of stroke happening to a patient.

With the month of September declared “Atrial Fibrillation [AF] Awareness Month,” Dr. Ramirez also took time out to discuss the disorder which is also known as a type of “arrhythmia” or irregular heartbeat.

Arrhythmia is caused by the uncoordinated pumping of the upper and lower chambers of the heart.

People suffering from AF can develop clots in the upper chambers. These “irregular” clots can circulate and cause blockages in the veins, and if it reaches the major arteries of important organs, this could lead to heart attack and stroke.

 The condition can develop in patients who are above 70 years old, have a pre-existing heart, kidney, or lung diseases, diabetes, and high blood pressure. Thyroid problems, sleep apnea, and metabolic syndrome can also cause AF.

Thrombosis

Thrombosis, or blood clotting, is a normal body function that prevents excessive bleeding due to a ruptured vein. This happens when platelets mix with a blood plasma protein called “fibrin” which coagulates blood to form a thin membrane to cover the area of the ruptured vein.

Clots usually dissolve overtime as the injured area heals. 

However, there are patients who suffer from irregular heart movements that could abnormally cause clotting which could result in fatal conditions.

These types of clots can travel to important organs and block the normal circulatory flow, thus disrupting their functions. This “moving” blood clot is called embolism and if left undetected, could lead to death.

Thrombosis can trigger a series of life-threatening conditions, including heart attack and stroke. A patient can develop blood clots if they are of old age, pregnant, obese, or smoking.

It can also happen to people suffering from hypercoagulability of the blood, has increased estrogen levels, experienced severe injuries or trauma to the body due to surgery or even cancer. It can also be hereditary.

 According to the Department of Health and the Food and Nutrition Research Institute, AF is common among Filipinos over the age of 70 years old. It poses a threat as it puts a patient at a higher risk for stroke. 

Since clots can happen to people suffering from AF, the deposits can sometimes reach the brain. That is why AF puts them at risk for stroke. Dr. Johnny Lokin of the Stroke Society of the Philippines discussed how clots can stop the blood flow to your brain and possibly cause a stroke.

Stroke, or “brain attack,” is the third leading cause of death, next to heart diseases and cancer, in the Philippines in 2020, according to the survey conducted by the Philippine Statistics Authority. Over 99,000 deaths were caused by stroke last year, a 2.3 percent jump from 2019, which had over 97,000 deaths reported.

AF creates thrombosis that is pumped to the brain, blocking major arteries that carry oxygenated blood, which is crucial for brain function. It is estimated that one-fourth of all strokes after the age of 40 are caused by AF. This condition is called, “ischemic stroke.” About 87 percent of all strokes are ischemic.

The brain cells and tissues can die within minutes due to the lack of oxygen and nutrients. Since a patient suffers from atrial fibrillation, the clots caused by AF clogs the arteries, resulting in fatal brain malfunction. 

Thrombotic stroke (stroke via blood clotting) would manifest in one or more “mini-strokes” called transient ischemic attacks (TIAs). TIAs may last for a few minutes or up to 24 hours and are often a warning sign that a stroke may occur. Despite this, AF-caused strokes can be prevented by taking anticoagulant (blood-thinning) medication.

Preventing stroke 

Dr. Lokin said that living a healthy lifestyle and controlled salt intake will help prevent stroke.

Baguhin ang diet [Change your diet],” Dr. Lokin said, stressing that those with maintenance medicines should religiously take their medicine.

Dr. Ramirez, on the other hand, lamented that some people are waiting to be ill first before addressing their situation.

According to the National Stroke Association, thrombotic stroke is preventable through medication adherence and compliance.

Medication adherence, or the taking of medications correctly as prescribed by the doctor, is another integral aspect of blood clots management that many patients usually take for granted.  

Adherence to medication is a key part of health care and affects all areas. Apart from compliance to medication, it involves following a recommended diet or implementing lifestyle changes that goes along with medical advice.

According to the World Health Organization, adherence helps improve cases of at-risk patients because both the patient and the physician collaborate to improve the patient’s status by integrating the physician’s medical opinion and the patient’s lifestyle, values and preferences for care.

 Physicians are advised to know the capacity of their patient to access the medicines they would need. This includes disclosing their financial ability and their access to a pharmacy at every appointment. Pharmacists should also help by explaining thoroughly to patients their refill programs, assistance, and generic medicine so that they are knowledgeable on their medication. 

Thrombotic stroke can be prevented with enough knowledge on its causes and with a thorough medication program to help the body fight off any signs of it.

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