‘It’s all in the genes’: The difference between blood clotting and bleeding

If a person with a predisposition to clotting sits in a cramped section on a plane for a long-haul flight, they tend to arrive at their destination with a very swollen leg, also known as deep vein thrombosis (DVT). A number of people who have gotten this condition have tried to sue the airline when, in reality, they should be suing their relatives for giving them one of the relatively common genes that increases the chances of blood clots.

These genes occur in around 1 per cent of the population. Any other factors such as recovery from an operation, prolonged sitting caused by sedentary jobs, or taking medications that may thicken the blood, such as the oral contraceptive pill or hormone replacement therapy, may precipitate an episode of thrombosis.

If you have a strong family history of blood clots, such as DVT, pulmonary embolus (clots travelling into the lungs), or even cases of premature heart disease it’s certainly worth a doctor’s visit to discover whether you have one of these common abnormalities. The most common types are Factor V Leiden (an inherited blood-clotting disorder) and anti-cardiolipin antibodies. Regardless of the specific diagnosis, we now have extremely effective treatments to prevent further clotting and potentially lethal complications.

To decreases the risk, a common blood-thinning medication used by patients is warfarin. It’s a highly effective blood-thinning agent but it’s also very difficult to take, requiring regular blood tests and both the doctor and the affected person being very careful in terms of the prescription and ingestion of a variety of medications, food and alcohol.

Over the last decade, there have been a handful of highly effective medications known as direct oral anticoagulant drugs which are more effective than warfarin, appear to be much safer and don’t require regular blood tests nor do they require the same rigidity with diet, alcohol and the prescription of a variety of drugs. But, it’s important to note, the stronger the blood thinner, the stronger the risk of bleeding.

Interestingly, on the other hand, there are a small number of people in the community who have genetic bleeding disorders such as those with haemophilia or the lesser-known condition Von Willebrand disease. Again, if you have a strong family history or personal history of easy bleeding or bruising, it’s worth being investigated for these bleeding disorders.

On another note, over the years there have been some suggestions that once we reach the age of 50, we should take a daily aspirin as a preventative against heart attack and stroke. There are even some suggestions that there’s a reduction in a variety of common cancers. So should we be taking aspirin daily? Three major studies released in 2018 suggested people shouldn’t take aspirin purely as a preventative against cardiovascular disease. The cardiovascular preventative aspects were outweighed by increased bleeding risk and other problems.

For the vast majority of the population, we have a delicate balance between clotting and bleeding, but for those outliers who are at either an increased risk of clotting or, at the opposite end of the spectrum, increased risk for bleeding, it’s important that they have a careful assessment with their doctor.