Anticoagulant Clinic

The Anticoagulant Clinic at Bangkok Hospital provides specialized care for patients requiring blood thinning treatments. Our expert team monitors and adjusts anticoagulant therapies to prevent complications such as blood clots, stroke, or deep vein thrombosis. With advanced diagnostic tools, we ensure accurate medication management tailored to each patient's needs. The clinic offers personalized consultations, helping patients maintain optimal therapeutic levels and reduce risks. Trust Bangkok Hospital’s Anticoagulant Clinic for comprehensive care and support in managing anticoagulation therapy.

Thrombosis is the process of forming a blood clot, where platelets aggregate and coagulation occurs, leading to the formation of a clot with red blood cells.

The benefit of thrombosis is its role in stopping bleeding, known as hemostasis, which is essential for survival. However, the danger arises when a thrombus (or embolus) blocks blood flow in veins or arteries. If this blockage occurs in vital organs, it can lead to life-threatening conditions. While hemostasis is crucial, the pathological formation of a thrombus poses significant health risks.

Thrombosis and embolism can occur under several conditions related to blood flow, vessel wall quality, and blood composition.

1. Nature of Blood Flow: Deep vein thrombosis (DVT) can develop in the legs due to prolonged immobility, causing blood stasis. This leads to swelling, pain, and redness in the affected leg. If the clot breaks free, it can travel to the lungs, causing a pulmonary embolism, which is a life-threatening condition. Blood clots may also form in the left atrial appendage of the heart in patients with atrial fibrillation, leading to embolism that can result in a stroke if the clot reaches the brain.

2. Quality of the Vessel Wall: Clots can form on foreign objects like metal heart valve prostheses or following endothelial cell injury. If the clot breaks off, it can travel to various parts of the body, potentially causing serious complications like stroke if it reaches the brain. Rupture of cholesterol plaques can also lead to heart attacks.

3. Blood Composition: Certain conditions, such as antiphospholipid syndrome, thrombophilia, malignancy, or sepsis, increase blood clotting tendency. These conditions cause hypercoagulability, leading to a higher risk of thrombus formation and embolism.

Thrombosis and embolism pose significant health risks, including stroke, heart attack, and pulmonary embolism, making early detection and treatment crucial.

Types of Thrombosis (Venous or Arterial)

1. Venous Thrombosis

   • Deep Vein Thrombosis (DVT): Formation of a blood clot in the deep veins, often in the legs.

   • Pulmonary Emboli: A clot that travels from the veins to the lungs, causing a life-threatening condition.

   • Thrombosis at Various Locations: Clots can form in veins throughout the body, leading to complications.

2. Arterial Thrombosis

   • Stroke: Clot formation in the arteries leading to the brain can cause a stroke.

   • Myocardial Infarction (Heart Attack): Blood clots in the coronary arteries can cause a heart attack.

   • Heart Valve (Prosthesis) Thrombosis: Clots may form on artificial heart valves, leading to embolism.

   • Systemic Emboli: Clots that travel to different organs, causing serious health risks.

Thrombosis Risks

1. Age: People over 60 years old are at higher risk.

2. Previous Blood Clots: History of blood clots increases the risk of recurrence.

3. Hormone Therapy: Certain hormonal treatments can increase clotting risk.

4. Cancer: Cancer or cancer treatments can elevate clotting risk.

5. Atrial Fibrillation: Irregular heart rhythms increase the likelihood of clots forming.

6. Immobilization: Prolonged immobility, such as after orthopedic surgery, stroke, or long-distance travel, can cause clot formation.

7. Foreign Bodies: Artificial heart valves or other metallic implants in blood vessels can lead to clot formation.

8. Hypercoagulable Conditions: Disorders like antiphospholipid syndrome or malignancy that increase clotting propensity.

Management of Thrombosis and Embolus

1. Prophylaxis

   • Pharmacologic:

     • Anticoagulants to prevent blood clot formation:

       • Heparin (Unfractionated and Low molecular weight)

       • Factor Xa inhibitors (indirect – Fondaparinux, direct – Rivaroxaban, Apixaban, Endoxaban)

       • Thrombin inhibitors (direct – Dabigatran)

       • Vitamin K antagonist (VKA) – Warfarin

     • Guidelines exist for prescribing anticoagulants in various conditions and stages.

   • Non-Pharmacologic:

     • Early mobilization and mechanical techniques to improve lower extremity venous circulation in deep vein thrombosis.

     • Inferior vena cava filter insertion for preventing pulmonary embolism.

     • Left atrial appendage occluder, atrial fibrillation radiofrequency (RF) ablation, and surgical maze procedure for atrial fibrillation and left atrial appendage thrombus.

2. Treatment

   • Pharmacologic:

     • Same anticoagulants used for prophylaxis, with specific guidelines for different conditions and stages.

   • Non-Pharmacologic:

     • Embolectomy for venous, arterial, or pulmonary thrombosis.

Bangkok Heart Hospital Anticoagulation Clinic Services

• Consultation: Diagnosis and management of thrombosis, along with appropriate anticoagulation treatment.

• Anticoagulation Management: Ensuring correct use of anticoagulants and enrolling patients for both short and long-term management.

• Complication Management: Addressing complications arising from anticoagulants.

• Surgical Procedure Support: Managing patients on oral anticoagulation who need surgical procedures.

Warfarin (VKA) and INR Management

• Specialized Team: Managed by a team of physicians, pharmacists, and nurses.

• Computer-Assisted Program: Use of technology for precise INR management.

• Evidence-Based Practices: Adherence to current protocols and nomograms based on evidence.

• Patient Education: Extensive education for patients and families.

• Improved Outcomes: Enhancing patient safety, cost-effectiveness, and convenience with accurate medical records.

INR Measurement Techniques

• Standard Venipuncture: Traditional method requiring a visit to the hospital or clinic for blood draws.

• Point Of Care Testing (POCT): Capillary fingertip testing for home use, also known as Patient Self Test (PST).

• Patient Self-Test (PST):

  • Requires strict quality control.

  • Suitable for patients with long-term anticoagulation therapy needs.

  • Patients must be willing to perform self-management and regularly attend clinics.

  • Competence in using the instrument and interpreting results is necessary.

  • Ensures increased INR testing frequency and fewer complications.

Therapeutic Time in Range (TTR)

• Bangkok Heart Hospital TTR: 65.8%

• Thailand National Average: 40%

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