Thrombosis (from Ancient Greek θρόμβωσις thrómbōsis 'clotting”) is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss.  Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel ...

thrombosis

Purpose-of-anticoagulants

Purpose of anticoagulants 

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Anticoagulants are type of a drug used if you are at risk of blood clots. They can potentially block a blood vessel and disrupt blood flow in the body. Also known as blood thinners, anticoagulants are chemicals that prevent or reduce blood coagulation by prolonging clotting time.

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Anticoagulants are available in many different forms, including injections, intravenous (IV) drugs and medicines you take orally (orally). They often treat and prevent life-threatening conditions that can occur due to blood clots, such as strokes, heart attacks and pulmonary embolism. [&nbsp;<a href="https://www.ncbi.nlm.nih.gov/books/NBK560651/" target="_blank" data-ref="Page not available - NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube" rel="noopener">[ref. 1]</a>&nbsp;]

What-are-the-advantages-and-side-effects-of-anticoagulants?

What are the advantages and side effects of anticoagulants?

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Anticoagulants are extremely effective in preventing these life-threatening conditions such as stroke, pulmonary embolism and heart attack. There are also several different ways in which these drugs work. This means that people who cannot take one medicine are likely to take another medicine with a similar effect.

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However, side effects are possible, and among the most common side effects with any anticoagulant is bleeding. Depending on the drug used, there are other potential risks, such as necrosis of the skin,&nbsp; severe PMS in women, bruising, bleeding gums, dizziness, headache, etc. [&nbsp;<a href="https://link.springer.com/article/10.1007/s40138-013-0014-6?error=cookies_not_supported&amp;code=29f13e37-8df2-4ff3-9d02-a5efc6c65811" target="_blank" data-ref="Anticoagulants: A Review of the Pharmacology, Dosing, and Complications - Current Emergency and Hospital Medicine Reports" rel="noopener">[ref. 2]</a>&nbsp;]

Natural-anticoagulants---who-are-they

Natural anticoagulants - who are they 

Garlic

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Besides its characteristic taste and numerous applications in culinary, garlic (Allium sativum) has natural antibiotic and antimicrobial properties. A&nbsp;2018 study published in Food Science and Biotechnology reported that garlic powder demonstrated antithrombotic activity in rats.<a href="https://www.herbal-organic.com/bg/pubmed/Allium_sativum_garlic_a_natural_antibiotic_6366484" target="_blank" data-ref="Allium sativum (garlic)--a natural antibiotic. | Билкови и природни лекарства" rel="noopener"></a> Antithrombotic agent is a substance that reduces the formation of blood clots. [&nbsp;<a href="https://link.springer.com/article/10.1007/s10068-018-0469-z?error=cookies_not_supported&amp;code=b65de6d1-7da4-49bf-9928-c1eb90c8aef4" target="_blank" data-ref="A comparative study of the antithrombotic effect through activated endothelium of garlic powder and tomato extracts using a rodent model of collagen and epinephrine induced thrombosis - Food Science and Biotechnology" rel="noopener">[ref. 4]</a>&nbsp;

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A review of studies from 2020 found that garlic supplements can help reduce blood pressure and have mild antithrombotic effects. [&nbsp;<a href="https://www.spandidos-publications.com/10.3892/etm.2019.8374" target="_blank" data-ref="Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis" rel="noopener">[ref. 5]</a>&nbsp;

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Vitamin-E

Vitamin E

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Vitamin E reduces blood clotting in several different ways. These effects depend on the amount of vitamin E a person takes.&nbsp;

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According to the National Institutes of Health (NIH), people taking blood thinning drugs should avoid taking large doses of vitamin E. However, it is not clear how much vitamin E dilutes blood, although people may need to take more than 400 international units (IU) per day. &nbsp;<a href="https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/" target="_blank" data-ref="Office of Dietary Supplements - Vitamin E" rel="noopener">[Ref. 6]</a>&nbsp;

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However, taking vitamin E can bring other health benefits, and it is recommended to provide it from foods such as almonds, sunflower seeds, spinach, peanut butter and others.

Ginkgo-biloba

Ginkgo biloba 

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Practitioners of traditional Chinese medicine have used leaves from the Ginkgo biloba tree (Ginkgo biloba) for thousands of years. &nbsp;<a href="https://www.herbal-organic.com/bg/pubmed/Ginkgo_biloba_13678141" target="_blank" data-ref="Ginkgo biloba. | Билкови и природни лекарства" rel="noopener">[Ref. 7] Ginkgo</a> is also a very popular herbal supplement in the USА and Europe. People take ginkgo biloba for blood diseases and memory problems, blood circulation and other issues.

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According to a 2019 study published in Bioorganic Chemistry, several compounds in ginkgo can block thrombin, which causes blood clotting. [ <a href="https://linkinghub.elsevier.com/retrieve/pii/S0045206819300628" target="_blank" data-ref="Redirecting" rel="noopener">[ref. 8]</a>&nbsp;

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Grape

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There is some evidence to suggest that grape seed extract may have potential benefits for several heart and blood diseases. Grapes can also help prevent high blood pressure, although research has shown rather mixed results.&nbsp;

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Grape seed extract can also act as a natural blood thinner. Therefore, the National Center for Complementary and Integrative Health recommends that certain groups of people do not take grape seed extract, including people with blood diseases; people who are taking blood thinning medicines and those who are about to have a surgery. &nbsp;<a href="https://www.nccih.nih.gov/health/grape-seed-extract" target="_blank" data-ref="Grape Seed Extract" rel="noopener">[Ref. 9]</a>&nbsp;]

Dong-quai

Dong quai

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Dong quai, also known as "female ginseng", is another traditional Chinese herb that can reduce blood clotting.

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This effect may be the result of the content of coumarin in ginseng. It is the same substance that makes cinnamon such a powerful anticoagulant.

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However, a small 2015 study in the journal Blood found that taking 1,000 milligrams of dong quai daily did not significantly affect blood clotting. The authors note that&nbsp; further research is needed to bring out conclusions.

There are various natural substances that can reduce blood clotting to some extent. Among them are ginkgo biloba, garlic, cinnamon, ginger and others. However, not all of them can be as effective as blood thinning drugs. People at risk of blood clots should not use them instead of prescription medicines.&nbsp;

What are the 10 natural anticoagulants [blood thinners] - Part 2

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What are the 10 natural anticoagulants [blood thinners] - part 

Бетина Цветкова

How-anticoagulants-work

How anticoagulants work

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Blood thinners are drugs that help blood flow smoothly through the veins and arteries. They also protect against blood clots or, if any, from increasing them. Anticoagulants are prescribed to treat certain types of heart disease and heart defects and other conditions that may increase the risk of dangerous blood clots. [&nbsp;<a href="https://www.ncbi.nlm.nih.gov/books/NBK537062/" target="_blank" data-ref="Page not available - NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube" rel="noopener">[ref. 1]</a>&nbsp;]

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Blood thinners can act in two ways. Antithrombocytes are drugs that stop cells in the blood (platelets) from clumping together and forming a clot. The formation of a blood clot, in turn, can lead to a heart attack or stroke. Aspirin is the most common antiplatelet. [&nbsp;<a href="https://link.springer.com/article/10.1007/s40138-013-0014-6?error=cookies_not_supported&amp;code=ec56544b-9ff6-41c5-9092-02591efcba03" target="_blank" data-ref="Anticoagulants: A Review of the Pharmacology, Dosing, and Complications - Current Emergency and Hospital Medicine Reports" rel="noopener">[ref. 2]</a>&nbsp;]&nbsp;

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Some examples of anticoagulants include:

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<ul><li style="font-weight: 400;" aria-level="1">Warfarin</li><li style="font-weight: 400;" aria-level="1">Heparin</li><li style="font-weight: 400;" aria-level="1">Dabigitran</li><li style="font-weight: 400;" aria-level="1">Apixaban</li><li style="font-weight: 400;" aria-level="1">Rivoraxaban</li></ul>Some of these drugs are synthetic substances that are derived from chemicals found in natural blood thinners. Chilli, cinnamon and ginger, for example, contain powerful compounds that are used to create anticoagulants.&nbsp;

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It is important to consult a doctor before trying natural foods, herbs or blood thinning supplements, as they may not be as effective as medicines, or may interfere with the action of certain medications.

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Some foods and other substances that can act as natural blood thinners and help reduce the risk of clots, we prepared in the upcoming selection.

Ten-natural-anticoagulants

Ten natural anticoagulants

Turmeric

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Turmeric (Curcuma) acts as a natural anticoagulant and has antiplatelet effects. A study published in BMB Reports shows that curcumin - the beneficial polyphenol in turmeric, inhibits the action of thrombin. [&nbsp;<a href="http://koreascience.or.kr/article/JAKO201213549741020.page" target="_blank" data-ref="												Anticoagulant activities of curcumin and its derivative				-BMB Reports						 | Korea Science" rel="noopener">[ref. 3]</a>&nbsp;] It is a protease that plays a role in blood coagulation.&nbsp;

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Another 2019 study published in the EPMA Journal states that turmeric can help block blood clotting and recommends taking care when combining turmeric with blood thinning drugs. [&nbsp;<a href="https://link.springer.com/article/10.1007/s13167-018-0158-2?error=cookies_not_supported&amp;code=7e3687c9-f322-4894-b11d-40130869f960" target="_blank" data-ref="Review of herbal medications with the potential to cause bleeding: dental implications, and risk prediction and prevention avenues - EPMA Journal" rel="noopener">[ref. 4]</a>&nbsp;

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Cayenne-pepper

Cayenne pepper

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Cayenne pepper (Capsicum annuum) contains salicylate - a natural blood-thinning agent that has been tested for its antithrombotic effects. In addition, it also contains capsaicin, which has been shown to have antihypertensive and antidiabetic properties. [&nbsp;<a href="https://www.herbal-organic.com/bg/pubmed/in_vitro_anti_inflammatory_anti_oxidant_and_cytotoxic_activities_of_four_i_curcuma_i_species_and_the_isolation_of_compounds_from_i_curcuma_aromatica_i_rhizome_32455782" target="_blank" data-ref="In Vitro Anti-Inflammatory, Anti-Oxidant, and Cytotoxic Activities of Four &lt;i&gt;Curcuma&lt;/i&gt; Species and the Isolation of Compounds from &lt;i&gt;Curcuma aromatica&lt;/i&gt; Rhizome | Билкови и природни лекарства" rel="noopener">[ref. 5]</a>&nbsp;] For these reasons, chilli can be taken as capsules (a dietary supplement) to promote cardiovascular health and circulation.&nbsp;

Cinnamon

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Cinnamon (Cinnamomum Verum), especially Cassia (Cinnamomum Cassia), is rich in coumarin. [&nbsp;<a href="https://www.herbal-organic.com/bg/herb/14482" target="_blank" data-ref="Cinnamon" rel="noopener">[ref. 6]</a>&nbsp;] This is a powerful anticoagulant that is actually used to make warfarin. However, research has shown that using cinnamon supplements for an extended period of time can be problematic and lead to liver problems. Therefore, it is always recommended to consume cinnamon as a spice to dishes or in drinks.&nbsp;

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Ginger

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Like chilli, ginger contains salicylate - a chemical that has been studied for its ability to prevent thrombosis. Studies have shown that salicylate has moderate anticoagulant properties and can prevent venous thrombosis without causing complications.

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The use of ginger because of its blood thinning properties is increasingly popular, but should not be combined with taking medications, according to experts.

Natural blood thinners help prevent blood clots that can lead to serious health problems such as a heart attack or stroke. Often conventional anticoagulants are prescribed to prevent dangerous blood clotting, but many of these drugs have adverse side effects.&nbsp; In the continuation of the theme we will introduce you to the potential anticoagulant action of garlic, vitamin E, Ginkgo biloba, grapes and Dong Kwai.

What are the 10 natural anticoagulants [blood thinners]

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Most common causes of recurrent pregnancy loss

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Many women's dream is to start a family, to watch how one, two, three or even more little people grow up before their eyes and become big girls and boys, full of dreams and a desire for adventure. Unfortunately, however, not everyone is favoured with this opportunity. About 2-2.5% of women undergo two or more miscarriages, which is defined as recurrent pregnancy loss (RPL) and may be associated with reproductive problems (1).

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In this article, we will discuss the most common causes, as well as other main factors that are believed to contribute to repeated miscarriages. Finally, we will talk about what type of tests can be done to establish the cause and what treatments and methods are applied to overcome this problem.

Most-common-causes-of-recurrent-abortions

Most common causes of recurrent abortions

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There are many reasons that are considered leading in repeated pregnancy loss. As science and medicine progress, the influence of more and more factors is proven, which sometimes creates differences in conclusions between different state reproductive organizations. As leading factors, genetic, anatomical, endocrinological and immunological problems are noted.

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Anatomical-factors

Anatomical factors

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Anatomical defects in the uterus occur in 10%-15% of cases of repeated abortions (6). It is believed that the way they contribute to a miscarriage is by cutting blood circulation to the lining of the uterus (endometrium), which in turn leads to a number of reproductive problems. The most common anatomical defects found in women undergoing RPL are congenital genetic defects, intrauterine adhesions and uterine fibroids or polyps (6).

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Intrauterus adhesions, often associated with Asherman's syndrome, are common in RPL. They can be developed after a coarse curettage or other surgical interventions of the uterus, birth by caesarean section, radiotherapy, endometriosis or various infections such as genital tuberculosis. Adhesions of the uterus are caused by the formation of a cicatricial connective tissue resembling scars of the endometrium and leads to a change in its size and shape. Depending on the size of conglutination, this condition may not constitute a problem or even lead to infertility (7).

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Uterine fibroids and polyps are also associated with recurrent pregnancy loss. Fibroids, also called myomas or leiomyomas, are harmless growths from the muscle tissue of the uterus, while polyps are growths from the endometrium. Many women have such excrescences but most do not pose a problem. These formations can lead to miscarriage by preventing the egg from being properly implanted into the uterus. According to the American Society for Reproductive Medicine, 5%-10% of sterile women have myomas (8).

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Genetic-factors

Genetic factors

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Genetic factors include mainly chromosomal abnormalities, which can usually occur with the development of the embryo or be inherited from the parents. It is believed that about 2%-8% of couples who suffer from repeated pregnancy loss have an abnormal karyotype (karyotype is the totality of all chromosomes) (2), but embryonic chromosomal abnormalities are rare in RPL (4). About 50%-60% of all early miscarriages are due to defects in the karyotype (2). The most common hereditary chromosomal abnormalities in recurrent pregnancy loss are translocations, with the most commonly observed in RPL being reciprocal (about 60% of the translocations) and Robertson translocations (about 40% of the translocations).

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Reciprocal translocation is called the exchange of genetic material between two different chromosomes, and Robertson translocation is the joining of the long arms of one chromosome with the long arms of another chromosome and of the short ones with the short ones, forming two wrong-sized chromosomes (4). Although we have no influence on these genetic events, most parents who carry such genetic defects give life to a perfectly healthy child. If you have already suffered a miscarriage caused by chromosomal abnormalities, the probability of a subsequent abortion for the same reason is very low.

Endocrinological-factors

Endocrinological factors

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17%-20% of recurrent pregnancy loss is associated with endocrinological problems in women. The main ones are polycystic ovary syndrome, diabetes mellitus, thyroid disease. Scientists are discussing the possibility that a defect in the luteal phase of the menstrual cycle may have an impact on RPL, but this is still up for debate. Polycystic ovary syndrome is found in at least 40% of women who go through repeated pregnancy loss (9).

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These women are known to have insulin resistance and hyperinsolemia, hyperandrogemia and increased levels of a plasminogen activator-1 inhibitor – factors that have been proven to interfere with the course of normal pregnancy (6,10). In women suffering from diabetes mellitus, there is no increased risk of miscarriage, as long as insulin and glycosylated haemoglobin levels are kept to normal (11). &nbsp;Similarly, women with hypothyroidism may have a normal pregnancy and a healthy child if maintaining normal levels of thyroid hormone. If levels are not regulated during pregnancy, the risk of abortion, as well as of congenital genetic problems of the child after birth increase (12).

Immunological-factors

Immunological factors

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With the development of science there is deeper understanding of the influence of immunological factors on RPL. During implantation of the egg in the uterus, in the formation of the placenta and in the development of the embryo, a large number of different immune processes are involved, immune teams of guards, the role of which is to accompany and preserve the normal course of all these reproductive processes.

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Unfortunately, however, in some cases, the immune cells – guards make mistakes and cause problems in pregnancy. A main such problem is antiphospholipid antibody syndrome, which occurs in 15% of patients who undergo recurrent abortions (13). This is a rare autoimmune disease in which the immune system mistakenly attacks parts of the cell membrane called phospholipids. The cells that make up the lining of blood vessels are damaged, which causes increased formation of clots in the blood. This is a major problem in pregnant women, because communication between the mother and the embryo happens by blood. This disease can lead to blockage of blood vessels in the placenta, which would interfere with the development of the embryo and therefore lead to miscarriage. Another immunological factor for RPL is considered the possibility of the mother organism not recognizing the fetus as its own and disposing of it. Since the embryo carries genetic information from both the mother and the father, the paternal antigens which the fetus presents may be identified as alien by the mother's immune system and the placenta may be discarded (14).

Other-factors-associated-with-THE-PA

Other factors associated with THE PA

Thrombophilia

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The main thrombophilia most often associated with repeated pregnancy loss are:

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(a) Hyperhomocysteinemia, which occurs from a mutation in a specific gene called methylenetetrahydrofolate reductase (MTHFR). Opinions in science are still conflicting about whether this gene has any connection to vascular diseases at all, but many of the women who undergo repeated abortions have this mutation.

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b) Resistance to activated protein C – occurs from a mutation in Factor V Leiden. This mutation is a major genetic change in thrombophilia, since with its presence it is considered that the body goes into a state of hypercoagulation.

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c) Deficiency of activated protein C and protein S – these can be both congenital and acquired as a result of liver diseases, some infections, vitamin K deficiency and others. Congenital protein C deficiency arises from a mutation in the PROC gene, and in protein S - from a mutation in the PROS1 gene.

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(d) Mutations in prothrombin and antithrombin.

Fragmentation-of-sperm-DNA

Fragmentation of sperm DNA

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In a large number of cases of repeated abortions the cause is not in the woman but in the other partner, whose genetic material is also transmitted to the fetus. Most men have a subpopulation of sperm in their ejaculate, the DNA of which is damaged before or during ejaculation. In some subfertile men, the number of such spermatozoa is increased and this may be associated with the advent of repeated miscarriages (18).

Impact-of-environmental-factors-on-the-occurrence-of-recurrent-miscarriages

Impact of environmental factors on the occurrence of recurrent miscarriages

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There are various factors which some people face every day, which may contribute to the risk of recurrent miscarriages. Daily alcohol, cigarettes and coffee intake are most commonly discussed. Drinking alcohol 3 times a week for the first 3 months or 5 times a week during pregnancy has been shown to increase the risk of miscarriages. Smoking cigarettes is associated with constriction of blood vessels due to the presence of nicotine in them, which reduces blood circulation to the placenta and can be the cause of miscarriage (6). Coffee intake can also be a factor in miscarriage, as has been demonstrated in some studies (16,17). Although there are clearly risks of taking these substances, no link has yet been found between their intake and RPL.

What-tests-can-you-do-to-find-the-cause?

What tests can you do to find the cause?

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A visit to the gynecologist is inevitable after a miscarriage. While you are in the office, hysteroscopy can be done – a study in which the doctor examines the condition of the uterus from the inside using a small camera. Another study that is done in a specific place for the procedure is a hysterosalpingogram. In this study, fluoroscopy is performed – a contrast agent is injected into the cervix, which diffuses along the uterus and fallopian tubes. The process is observed on an X-ray and it visualizes whether there is a blockage of the fallopian tubes.

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Conducting cytogenetic analysis is a commonly prescribed study in patients who have suffered repeated miscarriages. Cytogenetic analysis allows to see all the chromosomes of the patient after only one blood collection. Chromosomes are isolated from the blood cells and then stained by a special method, allowing them to be seen under a microscope and to find out if any chromosomal defects are present.

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Examination of hormones such as thyroid stimulating hormone (TSH), checking the ovarian reserve by examining follicle-stimulating hormone (FSH) and estradiol may be useful in RPL. If you experience irregular menstruation, it can be seen whether antithyroid antibodies are present, which are detected in 17%-33% of women who have suffered 3 or more miscarriages (19). Checking if insulin resistance is present may also be helpful after undergoing RPL.

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Since antiphospholipid syndrome is indisputably associated with repeated abortions, it is significant to test for the presence of anticardiolipin antibodies and lupus anticoagulant, which will indicate whether the patient has an increased risk of forming blood clots.

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Despite numerous associations of thrombophilia with miscarriages in women, they have not yet been accepted as a major factor in repeated abortions, but rather as an accompanying factor to other factors that make a greater contribution to the occurrence of such events. Nevertheless, it is advisable that women who have a history of thrombosis take a blood test for the presence of thrombophilia.

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Last but not least, it is important to establish whether the cause of RPL comes from the male partner by examining the seminal fluid for DNA fragmentation. There are several different methods that can be conducted for this analysis, but all of them evaluate whether there is damage in sperm DNA.

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Therapies-that-may-improve-the-chances-of-conception-in-RPL

Therapies that may improve the chances of conception in RPL

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If an anatomical problem is detected, it can be removed surgically which often gives good results. If there are genetic abnormalities, including fragmentation of DNA in spermatozoa, the best option is to approach various in vitro procedures. Therapy with insulin-sensitive agents such as metformin improves performance in women with polycystic ovary syndrome (20). If there is an increased risk of thrombus formation, therapy with low molecular weight anticoagulants, such as heparin, is recommended. For some women, it is even advisable to continue taking them during pregnancy. Other easy changes that can be done in everyday life that can have big impact on the improvement in the chances of conception is the management of a healthy lifestyle by both partners – healthy eating, more movement, no drinking of alcohol, coffee and no smoking cigarettes, taking vitamins and antioxidants.

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Conclusion

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Nowadays, about 25%-30% of women go through hardships to discover the cause of repeated abortions, many of which even remain unclear. It is believed that in about 40%-50% of cases the exact cause cannot be found (6). However, most women who undergo repeated miscarriages (about 70%-75% of them) subsequently manage to give life to a healthy child (3).

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Most common causes of recurrent pregnancy loss

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 Most common causes of recurrent pregnancy loss

Ивелина Янкова

Author: Rositsa Tashkova, Master of Molecular Biology and Microbiology

Stroke is a common but critical condition that needs modern medical care without a minute's delay. After stabilization of the condition of the patient, rehabilitation is needed in order to restore to the maximum extent their quality of life.

What-Types-Of-Stroke-Are-There

What Types Of Stroke Are There

What-Types-Of-Stroke-Are-There_0_0

There are three types of stroke: microinsult or transient ischemic attack (TIA); ischemic stroke and hemorrhagic stroke.

What-Types-Of-Stroke-Are-There_0_1

In the transient ischemic attack, no permanent damage to the brain occurs, and the symptoms subside quickly - within minutes or hours.

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More dangerous are ischemic and hemorrhagic strokes.

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In ischemic stroke, a blockage of a blood vessel (artery) in the brain is observed, which leads to malnutrition of the part of the brain where it happened. The cause may be a blood clot that clogs or narrows the vessel. This is the most common form of stroke.

What-Types-Of-Stroke-Are-There_0_4

In hemorrhagic stroke, a rupture of a blood vessel in the brain is observed, in which blood is poured and pressed into brain cells, damaging them.