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Is There a Test to Predict Risk of Blood Clots?

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Published on March 22, 2016

Is there a reliable test to determine whether a patient has a tendency to develop blood clots?  Andrew Schorr asks Dr. Naval Daver of MD Anderson Cancer Center to answer this and related questions.  Dr. Daver explores the reasoning and methodology behind thrombotic screening.

The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Incyte Corporation.

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Transcript | Is There a Test to Predict Risk of Blood Clots?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.          

Andrew Schorr:   

Dr. Daver, here’s a question we got from Glen from Kansas City.  Glen writes in, “I’m a newly diagnosed, 71-year-old PV patient, and I just watched a video where there was mention of a blood test to determine the propensity for blood clots.  My hematologist says there’s no reliable test of this kind, so could you advise what test or tests are available for that or not?”

Dr. Daver:             

All right.  So, there’s actually really—the simple answer would be no.  There are no blood tests per se that can tell us if this person will have the thrombosis or not.  But the more long answer, complicated, is that what we really look at is the hemoglobin and hematocrit.  So, if the hemoglobin is well controlled, and that means usually when we’re keeping it below 15 or 15.5, we know the risk of developing a blood clot in the next year or two for that patient is going to be low.

As opposed to somebody who has a hemoglobin uncontrolled above 15 or hematocrit above 45, we know those patients are at a higher risk—two to three times higher—of developing a blood clot in the next four to five years.  So there are now big studies, actually of Europe, that have been published and show that if we can keep the hematocrit below 45, that along with the baby aspirin, 81 milligrams once a day, is probably the best thing we can do to reduce the risk of clotting by maybe two to three times.  And that’s kind of what we recommend for all of our patients.  But other than that, there’s no specific clotting marker that really helps us pick out patients. 

 

Andrew Schorr:                  

One follow-up question for you, and that is I had a blood clot, two blood clots in my leg prior to being diagnosed with myelofibrosis.  And later, my hematologist said well, we can do some kind of genetic test to look if you have a certain factor related to clots. 

Dr. Daver:             

So that’s a good question.  So I think they are two different things, which may rarely overlap.  So when we see a young patient, let’s say below 60, who comes in with a blood clot, without a known diagnosis of PV or ET or myelofibrosis, we usually, if they’re really young and it’s a major clot, or if it’s a second clot in somebody who’s young and this is unexpected without prolonged immobility, we do a workup for multiple factors.  So, there [are] some clots that cause more venous diseases, like Factor V Leiden, protein C, protein S.

And then there are some that cause more arterial thrombosis, like phospholipid syndrome, PNH, which is another blood disorder, and then PV and ET can cause both.  So outside of the context of PV, if somebody had multiple, unexpected clots or one severe life-threatening clot, we would do that workup.  Now, the chance of a person having PV, which is kind of a rare disease, and plus one of these other, which are also rare diseases, is very, very rare. 

So once we usually know that somebody has PV, ET or MF and they have clots, we attributed that—I wouldn’t necessarily really look for another cause, because we really—I haven’t seen a patient who has both rare diseases.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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