Preventing, Managing, & Thriving with Thrombosis flipbook

Preventing, Managing,
& Thriving with
Thrombosis

Table of Contents

What is thrombosis? 3
4
Blood Clots: The First Six Months
10
“What determines what part of the body gets a blood clot?
Why do some blood clots go to the heart, whereas others go 11
to the brain or to the pulmonary arteries?” 12
13
“What are direct oral anticoagulants (DOACs) and how are they 15
managed differently from warfarin? I’m concerned that they may 17
not have a specific reversal agent. What do doctors do to manage 18
heavy bleeding or surgery in patients on DOACs?”
20
The Emergency Department For a Recurrent Blood Clot: What to Expect 22
24
Inflammation, Diet, and Health: What You Need to Know

Exercise: The Surprising Benefits

Stepping into Success: Exercise After a Blood Clot

A Guide to INR Levels

Just Relax: The Science Behind Using Meditation to Combat Stress
and Improve Your Health

Yoga: The Medicine You Didn’t Know You Needed

Anticoagulant Comparison Chart

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SAVING LIVES THROUGH EDUCATION AND PREVENTION

What is thrombosis?

Thrombosis is the formation of a blood clot, known as a thrombus, within a blood vessel. It prevents
blood from flowing normally through the circulatory system.

What is deep vein What is a pulmonary embolism (PE)?

thrombosis (DVT)? A pulmonary embolism is a blood clot
that has traveled to the
Deep vein thrombosis lungs. It often starts as
occurs when a blood a DVT. A piece of the
clot forms in a major blood clot can break off
vein, usually in the and be carried to the
leg. This blood clot lungs. A PE can block the
stops blood from flowing flow of blood to the lungs,
easily through the vein, causing serious damage
which can lead to swelling,
discoloration, and pain in the to the lungs and affecting a person’s
leg. It is often diagnosed with ability to breath. This can lead to
an ultrasound. serious injury and possibly death.

Did you know that blood clots can be fatal
or lead to life-long disabilities?

Know the Symptoms: Know Your Risk:

Deep Vein Thrombosis Blood clots are indiscriminate of age, gender, race,
(Blood Clot in the Legs): and ethnicity.

• Discomfort, heaviness, pain, • Major trauma, such as an automobile accident,
aching, throbbing, itching, or fall, or head injury
warmth in the extremities
• Surgery, especially hip or knee replacement
• Skin changes in the leg, such • Hospitalization
as discoloration, thickening, or • Genetic or acquired clotting disorder
ulceration • Prior blood clot or family history
• Immobility or reduced mobility
• Swelling of the legs, ankles, or feet • Leg paralysis
• Active cancer/chemotherapy
Pulmonary Embolism • Traveling for 4+ hours (via plane, car, or train)
(Blood Clot in the Lungs): • Elevated estrogen levels from oral contraceptives,

• Sudden shortness of breath pregnancy, or hormone replacement therapy
• Chest pain • Obesity
• Rapid or irregular heart rate • Age 70+
• Coughing up blood • History of heart attack or ischemic stroke
• Acute infection and/or rheumatological disorder
If you are experiencing these symptoms,
you should seek immediate medical
attention.

Blood Clots: The First Six Months

A Look at Life with Deep Vein Thrombosis (DVT)
and Pulmonary Embolism (PE)

If you’ve recently experienced a PE or DVT, you know that it can be an unnerving
experience. It can leave you feeling vulnerable and afraid that you might have another

episode.

It’s normal to have many questions about what you should expect after a DVT or PE.
Here is a closer look at what the six months after a blood clot can hold:

THE BODY’S RESPONSE In other cases, blood clots aren’t
absorbed, but the body continues
Your body is an amazing machine and it to function around them without any
will deal with your blood clot in its own problems.
way.
If you’re interested in learning more
Once a blood clot has occurred, the about how your body is dealing with
body can handle it in different ways. your blood clot, ask your doctor.
Sometimes, the body can absorb the They can provide more personalized
blood clot. The timeline for a clot to information.
be absorbed varies depending on
your body’s ability to break down the MEDICATIONS
clot, the size of the clot, and location
of the clot. It’s important to note that After being discharged from the
blood thinners, like warfarin, are meant hospital, you may be put on an
to stop clots from getting larger, not anticoagulant medication for
necessarily to dissolve them. six months or more.

Preventing, Managing, & Thriving with Thrombosis – North American Thrombosis Forum

THE FIRST SIX MONTHS

Many patients are initially told that they INR level, despite their best efforts.

will be on anticoagulation medicine In fact, several studies show that only

(also known as “blood thinners”) for about 60 percent of patients at a clinic

the first six months after their blood have INR levels in the therapeutic range

clot. However, research is showing that at a time. Anticoagulation management

blood clots, also known as thrombosis, clinics help patients keep their INR

may be a chronic disease. According levels in the target range. Ask your

to Dr. Samuel Goldhaber, the director doctor if they refer patients to an

of Brigham and Women’s Hospital’s anticoagulation management service.

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If you’re put on warfarin, you’ll need to foods, but they need to be consistent in
make several lifestyle adjustments. how much they eat each day.

After an initial diagnosis, many patients Patients should also be aware of how

are put on warfarin. This is a traditional much alcohol they are drinking while

treatment that has been used for on warfarin. While it is recommended

several decades. While warfarin is very that patients avoid it all together, they

helpful, it has some challenges. should not drink more than one to two

drinks per day. Alcohol becomes a

Patients on warfarin need to visit a problem when it changes how the body
clinic regularly to have their INR levels metabolizes warfarin.

tested. An INR level measures how For some, the need to visit a clinic for

much time it takes for a patient’s blood INR testing on a regular basis can be

to clot. Most patients need to maintain inconvenient. Depending on a patient’s

an INR level between 2.0 – 3.0 to be insurance coverage, home-testing can

considered in ‘therapeutic range.’ be a better option. This involves buying

Warfarin works differently for each an in-home testing kit, which includes
person and INR levels can change from an INR monitor and testing strips similar
day to day. There are many patients to those used in clinics. Patients are
who struggle to maintain a consistent trained by a medical professional to test

Preventing, Managing, & Thriving with Thrombosis – North American Thrombosis Forum

THE FIRST SIX MONTHS

themselves and then self-report their approved in 2015, reverses dabigatran.
INR levels to their clinic. It is often used in cases where a patient
is experiencing a life-threatening bleed
You may be prescribed a DOAC over or needs emergency surgery.
warfarin.
“For the factor Xa inhibitors (apixaban
Many patients are prescribed direct and rivaroxaban) there is a reversal
oral anticoagulants (DOACs) instead of agent called andexanet alfa that
warfarin after having a blood clot. While appears to work really well and is safe,”
warfarin has dominated the market explained Dr. Ruff. “It acts as a decoy,
for the past 50 years, DOACs are now binding to the factor Xa inhibitors and
the recommended guideline-approved preventing them from exerting their
treatment for thrombosis. These drugs anticoagulant effects.”
include rivaroxaban, dabigatran,
apixaban, and edoxaban. Unlike Andexanet alfa was just approved by
warfarin, these drugs don’t require the FDA in 2018 to reverse apixaban
regular blood draws, have minimal drug and rivaroxaban.
and food interactions, and they have a
lower risk of bleeding than warfarin. To learn more about the specifics of
these medications, please see NATF’s
“We now have four approved Anticoagulant Comparison Chart.
alternatives to warfarin called DOACs,”
explained Dr. Christian Ruff, who When it comes to medication, every
works in the cardiovascular division of patient has a different experience
Brigham and Women’s Hospital. “In based on their past medical history,
general, the DOACs are more effective their diagnosis, their lifestyle factors,
than warfarin and safer, particularly and more. It’s important to ask your
with respect to serious bleeding. doctor any questions you have about
DOACs cause half as much fatal and your personal medication. Pharmacists
life-threatening bleeding than warfarin. can also be a valuable resource for
Also they are more convenient than questions about different medications
warfarin in that they do not require and their interactions.
frequent blood monitoring and can be
given safely in fixed doses.” FOLLOW-UP CARE

While there are many benefits to It’s important to schedule follow-up
DOACs, some doctors and patients care after your blood clot.
have been hesitant to use them. One
key concern has been the ability to After experiencing a blood clot,
reverse the effects of the DOACs. Until patients should follow up by scheduling
recently, reversal agents for these drugs an appointment with their primary
weren’t available. Today, two reversal care physician and establishing a
agents have been approved by the network of care. From there, patients
FDA, idarucizumab and andexanet alfa. may be referred to specialists, such
as a cardiologist, hematologist,
Idarucizumab, a once-a-day medication pulmonologist, or vascular medicine
specialist. These specialists can help

Preventing, Managing, & Thriving with Thrombosis – North American Thrombosis Forum

THE FIRST SIX MONTHS

steer patients towards the best The decision to undergo genetic
treatment for their individual needs. testing is a personal one that can affect
families. If you would like to learn
It is especially important for patients more about this option, please see the
to follow up with a doctor if they’ve National Human Genome Research
had an inferior vena cava (IVC) filter Institute and talk to your doctor about
put in their body to stop any clots from what resources are available to you.
traveling to the lungs. Some of these
filters are only temporary and a doctor COMPLICATIONS AFTER
must decide when it’s best for it to
be removed. They are often removed A BLOOD CLOT
after a patient’s risk for PE or DVT has
gone down and the benefits no longer It’s important to pay attention to what
outweigh the risks. your body is telling you.

After a clot, patients often believe that While many people do not experience
a new ultrasound should be part of another blood clot after they’ve had
their follow-up care. They want to see if their first, patients with a history of
their DVT has gone away. However, this blood clots are still at a greater risk
is not necessary. As mentioned above, than the general public. Patients who
the body often absorbs a blood clot have experienced a blood clot already
or creates a way to work around it. An are roughly 25 percent more likely to
ultrasound is only necessary if a patient experience a second episode. The
is experiencing new or worsening risk goes down over time and varies
symptoms, or if a patient is changing between patients with provoked and
medications. Also, many patients retain unprovoked blood clots. It’s important
some residual clot, like a scar, that is to watch for the warning signs of a new
absorbed into the wall of the vein but blood clot.
can be seen via ultrasound. This is not
necessarily associated with a poor For a DVT, symptoms include swelling
prognosis. and pain in the legs, especially behind
the knee. This pain often feels like a
There are genetic tests that can tell you long-lasting cramp. Symptoms for PE
if your family is prone to blood clots. are centered in the chest or in the back.
They include pain, shortness of breath,
Patients with DVT or PE may want to fatigue, or coughing up blood.
get genetic testing done. Genetics can
make some patients and their families After a DVT or PE, it’s normal for you
more likely to get blood clots. This to experience some discomfort as you
often happens because of a mutation recover.
that occurs and is passed through a
family line. Two mutations that can Patients with a DVT often still have
cause patients to be more prone to swelling and soreness in their legs. They
blood clots are Factor V Leiden and the may also experience post-thrombotic
prothrombin gene mutation. syndrome.

Preventing, Managing, & Thriving with Thrombosis – North American Thrombosis Forum

THE FIRST SIX MONTHS

Likewise, patients with PE may still Goldhaber recommends that patients
experience mild chest pain, back wear them for two years after their
pain, or shortness of breath. The level blood clot. It is important to replace
and length of this discomfort varies compression stockings every 3 months,
greatly between patients. Patients as the compression does break-down
with PE are also at risk for developing over time.
chronic thromboembolic pulmonary
hypertension (CTEPH). This occurs If your doctor prescribes compression
when a blood clot in the lungs causes stockings for you, it is important to
high blood pressure. fill that prescription and not purchase
“over the counter” compression
It can often be difficult to distinguish stockings, which might be less effective.
between the symptoms of a new
blood clot and the residual pain from ACTIVITIES
a previous one. Always contact your
doctor if you have concerns about new You’ll get back to doing your favorite
or ongoing symptoms. things again.

COMPRESSION STOCKINGS After a DVT/PE, patients want to
resume their lives. This can be more
Compression stockings can help you difficult for people who enjoy certain
deal with uncomfortable swelling after physically challenging activities.
a DVT and can prevent additional
problems. One of the most common life-style
questions that Dr. Goldhaber gets from
It’s normal for patients with DVT to his patients in the winter is, “When can
experience swelling in their legs after I go skiing again?”
a blood clot. In order to treat that,
many doctors prescribe compression Dr. Goldhaber advised that patients
stockings for their patients. These on anticoagulants avoid vigorous
stockings are personalized to each activities because they have a higher
patient’s condition, with different risk of causing bleeding. This can
patients requiring different types include skiing, boxing, playing football,
of stockings. Some stockings apply horseback riding, and a variety of other
the same amount of pressure to the activities.
whole area they cover, while others
apply different amounts of pressure to However, hope isn’t lost. After a
different parts of the leg. There are also six-month period, it may be safe for
different lengths of stockings (knee high patients to return to these activities
or thigh high) and different strengths with the approval and guidance of their
of stockings (how much pressure the doctor.
stockings put on your legs).
You need to stay active.
These stockings help prevent swelling,
along with pain. They can also help While patients may need to wait to
with post-thrombotic syndrome. Dr. resume vigorous activities, it’s still
important that they stay active and

Preventing, Managing, & Thriving with Thrombosis – North American Thrombosis Forum

THE FIRST SIX MONTHS

exercise. It improves cardiovascular If you have an activity that you’d like
health and helps prevent a recurrent PE to get back to or if you’d like to start
or DVT. exercising, always consult your doctor
before making any changes to your
“If you’ve recently been diagnosed lifestyle or medication.
with a PE, you may feel short of breath,
have chest pain, and/or become easily REFERENCES
fatigued when you start exercising.
Following a DVT, your leg may be For more information on any of the
swollen, tender, red, or hot to the following, please visit NATFonline.org:
touch,” explained Dr. Stephanie Lew
in A Heart Healthy Tip: How to Safely • Post-thrombotic syndrome
Start an Exercise Routine After A • NATF’s Anticoagulant Comparison
DVT or PE. “These symptoms should
improve over time, and exercise often Chart
helps. Walking and exercise are safe to • Chronic thromboembolic
do, but be sure to listen to your body
to avoid overexertion.” pulmonary hypertension (CTEPH)
• Compression stockings
• NATF’s in-person and online

support groups

YOU ARE NOT ALONE

Blood clots can bring a lot of uncertainty into your life, especially during the first
six months after your diagnosis. NATF is here for you. We strive to be a resource
that you can rely on throughout your journey. Join us for one of our in-person
or online support groups to learn about how other people have handled their
experience with blood clots, or consider attending one of our educational
events to keep on top of the latest research.

Looking for something else?
We are just a phone call or email away.
Email: [email protected]
Tel: 617-730-4120

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

“What determines what part of the body gets
a blood clot? Why do some blood clots go to the
heart, whereas others go to the brain or to the pulmonary
arteries?”

T he ability to form blood In deep vein thrombosis (DVT), are the arteries to the brain, and
clots is critical for the blood clots develop in the leg a blood clot passing out of the
body to prevent excessive or pelvis veins in the absence of heart and into these arteries can
bleeding. When a blood vessel obvious damage to the vessel. cause a stroke.
is damaged, cells in the blood Within the vessel, a combination
called platelets interact with of microscopic injury to the Aaron W. Aday, MD
various clotting proteins to form vein wall along with abnormal Cardiovascular Medicine
a clot. This effectively “plugs up blood flow and a propensity for Fellow, Brigham and
the hole” to stop the bleeding. blood clots all contribute to DVT Women’s Hospital
Over time, the clot typically formation. Inflammation and
dissolves as the body repairs the underlying genetic factors likely Do you have a question for
blood vessel damage. However, predispose people to DVT, and the expert? Email info@
in some cases, blood clots may other risk factors such as cancer natfonline.org
develop inappropriately and or immobility also increase
become deadly. risk for DVT. If a portion of the
DVT dislodges, it can travel
Blood clots play a major role through the veins and relocate
in myocardial infarction (MI), in the pulmonary arteries,
or heart attack. Over time, the thereby becoming a pulmonary
coronary arteries can develop a embolism (PE).
buildup of cholesterol, fibrous
tissue, and inflammatory cells in Finally, blood clots also play a
a process called atherosclerosis. role in stroke. When the heart is
Important risk factors for this in normal rhythm, blood flows
include smoking, hypertension, briskly through each chamber.
high cholesterol, and diabetes. However, in atrial fibrillation,
blood has more opportunity
This buildup coalesces in various to stagnate in the atria, or top
segments of the arteries in chambers of the heart. With less
structures called plaques. In movement, blood is more prone
some cases, these plaques to clotting, and blood clots may
become unstable and fracture, develop in the left atrium of
which triggers the body to patients with atrial fibrillation.
form a blood clot at that site. Once they form, they can be
The blood clot may block the pumped out of the heart and
coronary artery and starve a into the body’s arterial system.
portion of the heart muscle Some of the first arteries blood
of oxygen and nutrients, thus reaches once it leaves the heart
causing an MI.

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

“What are direct oral anticoagulants (DOACs)
and how are they managed differently from
warfarin? I’m concerned that they may not have a specific
reversal agent. What do doctors do to manage heavy
bleeding or surgery in patients on DOACs?”

F or over half a century, blood monitoring and can be Xa inhibitors and preventing
vitamin K antagonists, given safely in fixed doses. them from exerting their
such as warfarin, were the only anticoagulant effects.
available oral anticoagulant. Despite the attractiveness of
Although very effective in these new agents, adoption Although certainly these
reducing stroke in patients has been slow. There are antidotes or reversal agents
with atrial fibrillation and many reasons for this, but are a welcomed advance and
treating and preventing venous one important aspect is the have given tremendous comfort
thromboembolism, warfarin is issue of reversal. Although to physicians and patients, we
one of the most difficult and warfarin causes much more must remember that serious
dangerous drugs we use in serious bleeding than DOACs, bleeding with the DOACs is very
clinical practice. The biggest physicians and patients are uncommon, so these agents will
concern is serious bleeding, comforted by the notion that need to be used infrequently.
particularly intracranial they can reverse warfarin with For most mild bleeding with
hemorrhage which is frequently vitamin K and administration DOACs, simply holding 1-2
fatal or results in permanent of clotting factors. Although doses of the drug [they all have
neurologic disability. the “reversal” of warfarin is a very short half-lives] and general
bit of a myth, the lack of an supportive measures are all that
Over the past few years, we ability to reverse the DOACs is needed.
now have four approved is a perceived limitation of
alternatives to warfarin called these agents. There is now an Christian T. Ruff, MD, MPH
DOACs – originally called novel approved reversal agent for
oral anticoagulants but now factor IIa inhibitor dabigatran TIMI Study Group
more commonly referred to as called idarucizumab. It is an Cardiovascular Division
non-vitamin K antagonist oral antibody to dabigatran and Brigham and Women’s
anticoagulants or direct oral reverses the anticoagulant Hospital
anticoagulants (DOACs). In effect of dabigatran within Harvard Medical School
general, the DOACs are more minutes and has no apparent
effective than warfarin and side effects. For the factor Xa Do you have a question for
safer, particularly with respect inhibitors [apixaban, edoxaban, the expert? Email info@
to serious bleeding. DOACs rivaroxaban] there is a reversal natfonline.org.
cause half as much fatal and agent called andexanent alfa. It
life-threatening bleeding than is specifically approved by the
warfarin. Also, they are more FDA for the reversal of apixaban
convenient than warfarin in that and rivaroxaban. It acts as a
they do not require frequent decoy, binding to the factor

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

The Emergency Department For a Recurrent
Blood Clot: What to Expect

T aking a trip to the Performance Improvement for you visit. First, after waiting to
emergency department the Department of Emergency be seen, a medical professional
is something that very few Medicine of the Brigham and will take your medical history.
people enjoy doing. It can be Women’s Hospital, shared his In order to help your physician
very stressful, there’s a lot of insight on what patients with a provide the best treatment
waiting involved, and it can history of DVT/PE should watch for you, it’s important to know
be costly. However, for many for. all of the medications you’re
patients it can be a life-saving on. Keep an up-to-date list of
trip. For patients with deep For patients with a history medications in your wallet, or
vein thrombosis or pulmonary of DVT, they should be bring the pill bottles with you. If
embolism, it is especially concerned with any changes in you’re going to a new hospital,
important that they receive the their symptoms that concern bringing copies of your previous
treatments they need in a timely circulation. This includes losing DVT/PE images can also be very
manner. feeling in the affected leg or helpful for your physician.
profound discoloration of the
If you believe you may have leg. Once you’ve provided your
a blood clot, it is important medical history, you will then be
for you to seek treatment, For patients with a history of PE, examined and the physician will
especially if you have a history of determining if there is a new PE decide what steps to take next.
deep vein thrombosis (DVT) or can be difficult. They will take into consideration
pulmonary embolism (PE). your symptoms and your
“In someone who’s had PE, medical history, including past
When should you go to the there’s not an easy way to blood clots.
classify new symptoms,”
emergency department? explained Dr. Schuur. “But, Imaging is often the next step
a change in or worsening towards diagnosis. This can
If you’ve had PE or DVT of the patient’s symptoms, happen in several ways.
previously, it can be hard to especially worsened chest pain
differentiate between the pain and shortness of breath, or a For DVT, an ultrasound is the
brought on from a previous patient passing out would be most common diagnostic test.
episode and possible symptoms concerning and reasons to go This form of imaging uses sound
of a new issue. It is common for in.” waves to create a picture of the
patients who have had DVT to arteries and veins in the leg.
experience pain in the affected What can you expect if Doctors can also order a blood
leg, which can be brought on test known as the D-dimer test.
by post-thrombotic syndrome. you believe you are having
Similarly, it is also normal for In order to diagnose PE, doctors
patients with PE to experience a recurrent pulmonary can use imaging tests such as
chest pain and shortness of computed tomography (CT)
breath while their body is embolism or deep vein scans and magnetic resonance
healing. imaging (MRI) scans. CT scans
thrombosis? are the more popular diagnostic
Dr. Jeremiah Schuur, Director tool, but doctors will avoid using
of Quality, Patient Safety and While every patient’s trip to
the emergency department
is different, there are several
things that you can expect when

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Inflammation, Diet, and Health: What You Need
to Know

I nflammation is a hot topic in What scientists do know is Mediterranean Diet
the medical community. It has that inflammation can be
been shown to increase the risk triggered by diseases that arise So what type of diet can help
of thrombosis (blood clots) and from unhealthy eating habits. you battle inflammation? Dr.
cardiovascular disease. According to Dr. Mozaffarian, Mozaffarian suggests the
that knowledge is the most Mediterranean diet.
With this knowledge, you can be direct and well-established
empowered to take control of connection between diet and “For general health, I think that
your health. By understanding inflammation. the most important thing is to
how your behavior contributes focus on eating healthy foods,”
to inflammation, you can use this “We know poor nutrition overall he explained. “My simple rule is
new information to reduce your causes metabolic dysfunction, a high healthy fat Mediterranean
own risk of developing health in particular insulin resistance diet. This involves a lot of
issues. and ultimately obesity. Those healthy fats from fish, oils, nuts,
are major pathways for active and plenty of fruits, vegetables,
One way you can do that is by inflammation,” Dr. Mozaffarian beans, and whole grains. Then,
monitoring your diet. said. “Similarly, a good diet not a lot of packaged or fast
can improve metabolic risk and foods.”
The Connection Between separately lead to weight loss,
which can dramatically improve The “Mediterranean diet”
Diet and Inflammation inflammation.” mimics the natural diets of
people who live along the
There are many different “Independent of insulin and Mediterranean Sea.
theories about the connection weight-related pathways, I
between different foods and think there’s a lot of theories of According to the Mayo Clinic,
inflammation. While many possible inflammatory effects the Mediterranean diet involves:
scientists know there is a of different types of foods,”
connection, the details of the Dr. Mozaffarian remarked, • “Eating primarily plant-
connection have not been explaining some of the nutrients based foods, such as fruits
discovered yet. Inflammation believed to be involved in and vegetables, whole
can be caused by many different controlling inflammation. grains, legumes, and nuts.
factors. “Probably the most studied are
Omega 3 fatty-acids, antioxidant • Replacing butter with
“Inflammation is complicated vitamins, and newer bioactive healthy fats, such as olive
and there are multiple pathways flavonoids that are found in oil and canola oil.
that are relevant,” explained cocoa and teas. All of those
Dr. Dariush Mozaffarian, Dean in experimental models have • Using herbs and spices,
of Tufts Friedman School of anti-inflammatory or antioxidant instead of salt to flavor
Nutrition Science and Policy. effects and clearly that’s foods.
“I think that a lot of this is still important. But, I think we’re still
in the area that I would call trying to understand how that • Limiting red meat to no
emerging research. There’s not a interaction works.” more than a few times a
lot that is definitive.” month.

• Eating fish and poultry at
least twice a week.”

PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Inflammation, Diet, and Health: What You Need to Know

The diet also involves lifestyle for the primary prevention of Take Control of Your
changes, such as getting lots cardiovascular disease.”
of exercise, eating meals Health
with family and friends, and, Foods to Avoid
surprisingly, drinking red wine By eating healthy, you
in moderation. By avoiding unhealthy foods, can reduce your risk of
you can stop inflammation developing inflammatory-
A 2013 study published in before it begins. risk factors, such as diabetes
the New England Journal of and metabolic syndrome.
Medicine tested the power “The main things to avoid in You also reduce your risk of
of the Mediterranean diet. the food system are starch, developing bad cholesterol.
Participants were divided into sugar, and salt,” explained Dr.
three groups. One group was Mozaffarian. Choosing a healthy life
assigned to eat a Mediterranean will allow you to lay a solid
diet supplemented with Trying to reduce these things foundation for your future.
extra-virgin olive oil. The can be difficult, because they It’s never too late to get
second group was assigned are found in many different started. Take control of
to eat a Mediterranean diet food products. It can help to your health by embracing
supplemented with nuts. avoid buying pre-packaged, nutritious foods and regular
Finally, the third group was overly processed foods. When exercise. It will help you stay
assigned to a control diet. All shopping, you should also avoid healthy and blood clot-free.
of the study participants had buying white bread, white rice,
no cardiovascular disease at and certain pastas, as they all
enrollment but had either type 2 contain high levels of starch.
diabetes or at least three major
risk factors for cardiovascular The worst foods you could
disease. have? Soda and candy,
according to Dr. Mozaffarian.
The study found that the
Mediterranean diet lowered the “There’s no reason ever to have
risk of cardiovascular disease by soda,” he remarked. “If people
30 percent in trial participants. It want a sweet, have a little bit
also lowered participants’ risk of of ice cream or dark chocolate,
stroke. have nuts covered in honey,
have something that actually
Researchers concluded, “in has food in it and has other
this primary prevention trial, nutrients.”
we observed that an energy-
unrestricted Mediterranean diet, Dark chocolate, he explained,
supplemented with extra-virgin is made from cocoa beans, and
olive oil or nuts, resulted in a ice cream has milk in it. Candies,
substantial reduction in the risk such as Skittles and gummy
of major cardiovascular events bears, have no such natural
among high-risk persons. The bases.
results support the benefits
of the Mediterranean diet

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Exercise: The Surprising Benefits

F rom signing up for a new them into energy. The increased Not ready to become a
gym membership, to levels of autophagy from professional athlete? That’s
restarting a running routine, exercise seem to protect against okay.
many people are diving into diseases, such as cancer and
exercise, but why? What does neuro-degeneration. Though “You actually need relatively
exercise have to offer? the process of autophagy has little amounts of exercise to
been explored, doctors still get a lot of health benefits,”
More than you might think. don’t know the full extent of the said Dr. Baggish. He described
benefits it brings. the recommended 150 minutes
The benefits of exercise are a week of heartbeat-raising
deep and go beyond what many Exercise can not only reverse exercise as a “sweet spot.” It’s
might expect. While it’s well the aging process, it could also the “optimum dose” of exercise
known that it makes people prolong life. Athletes who work that people need in order to get
healthier and helps with weight out regularly have strong hearts the most health benefits.
loss, many people don’t truly and slower heartbeats. Why
know what effect their daily is a slow heart beat healthy? Looking to the Future
exercise routine has on their Because there may be a limited
bodies. amount of them, according to One of the greatest health
one theory that Dr. Baggish threats today is the sedentary
Turn Back the Clock, shared. The theory states that lifestyle that people are living.
the heart has a limited number
One Run at a Time of beats. Based on that theory, a “We need to get people who
slower heart rate could increase are completely inactive to move.
“Introducing exercise at any people’s life spans. Our society is so geared toward
point in life has the potential promoting physical inactivity,”
to reverse the aging process Not buying into the theory? Dr. explained Dr. Baggish.
quite dramatically,” explained Baggish explained that a lower “Everything around us allows us
Dr. Aaron Baggish, the associate heart rate is also metabolically to be inactive if we choose to
director of the Cardiovascular more efficient, which is very be.”
Performance Program at the beneficial for the body.
Massachusetts General Hospital Looking forward, Dr. Baggish
Heart Center. Dr. Baggish Beyond physical benefits, hopes that science can help
specializes in sports cardiology exercise is also great for uncover new ways to make
and works closely with a variety mental health. According to Dr. physical activity a greater part of
of athletes. Baggish, physical activity can be daily living by finding new ways
a powerful anti-depressant and to motivate people.
One key process behind this can help fight anxiety. Exercise
“reverse aging” is called can stimulate the sympathetic One possible solution could
autophagy. The increased stress nervous system, leading be new wearables that are on
that exercise puts on the body to better sleep, increased the rise, such as Fitbits and the
causes cells to increase their alertness, and elevated moods. Apple Watch. Numbers and
levels of autophagy, a process metrics can be encouraging.
that acts as a recycling system. “There’s no question that Many people enjoy counting
It takes the worn-out parts of exercise is an effective cognitive their steps and knowing how far
the cell, which are connected stimulator,” he explained. they’ve walked or how many
to the aging process, and turns

PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Exercise: The Surprising Benefits

calories they’ve burned. Many Taking Action
have even turned it into a game,
competing against friends Feeling inspired? Now is your
and family by comparing their time to start exercising. It’s
results, such as who walks the never too late to take steps
furthest in a day. towards a healthier lifestyle.
If you’re not sure where to
While Dr. Baggish believes begin, even simple walks
that numbers and metrics around your neighborhood
can motivate certain people, can be a good place to start.
he stressed the need for What really matters is that
a continued commitment you’re getting your heart
to developing accurate pumping.
information. He’s personally
found that devices today tend The key is to get up, get out,
to have problems accurately and move.
measuring how many calories
people have burned. This
becomes an issue when people
are trying to balance how many
calories they take in with how
many they put out.

Looking forward, he would also
like to see devices that can
measure oxygen consumption
and sweat rates, to help athletes
with their training.

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SAVING LIVES THROUGH EDUCATION AND PREVENTION

Stepping into Success:
Exercise After a Blood Clot

After experiencing a blood clot, which can appear as a pulmonary embolism (PE), a blood clot in the
lungs, or deep vein thrombosis (DVT), a blood clot in the arms or legs, it’s important to get back into
exercising. For many people, this can be a challenge.

Here are some easy exercises you can do to help you get back to your best self:

Beginner Walking Program Strength Training with or without

Try to choose a route that is close to Lifting Weights
home, relatively flat, and has plenty
of places to rest along the way. For It is safe to return to your routine if
example, a local park or a shopping mall. you already have a strength training

Warm up by walking slowly for 5 minutes. program. If you want to begin
weight training, and have
Week 1: Walk for 5 minutes at a never lifted weights before,
comfortable pace, 3‐4 times per day. it is recommended that you
seek professional advice.
Week 2: Walk for 10 minutes, 3‐4 times per day. Ask your primary care
physician for a referral to a
Week 3: Walk for 20 minutes, 3 times per day. professional who can create
an individualized strength
Week 4: Walk for 30 minutes, 2 times per day.
training program for you.
Week 5: Walk for 40 minutes, once daily.

Cool down by walking slowly for 5 minutes.

Your goal is to walk for 30 to 45 minutes,
5 to 7 days per week.

Preventing another blood clot

There are many Ankle Pumps
reasons why Sitting in a chair, move your
someone might feet up and down as in the
develop a blood picture (30 repetitions/hour)
clot. One of those
risk factors is Knee Extensions
long periods of Straighten one knee, then slowly
decreased activity, lower your foot to floor, bending
such as sitting on a plane or in a car for several your knee. Repeat on your
hours. While there is a very low overall risk of opposite leg. (30 repetitions/hour)
developing a blood clot due to long periods of
sitting, periodic movement may help prevent Seated Marching
another blood clot. For any plane or car trip Sitting in a chair, slowly lift your
longer than 4 hours, if you are safely able to knee up as much as possible
do so, get up from your seat and walk for five in a marching movement, then
minutes every hour or two. In addition, perform slowly lower it. Alternate legs.
the following exercises in your seat every hour. (30 repetitions/hour)

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

A Guide to INR Levels

A fter being diagnosed with for them. If an INR score is too What can I do to help
a blood clot (thrombosis), low, a patient can be at risk for a
many patients are prescribed blood clot. However, if the INR keep my INR level where it
warfarin for treatment. Warfarin is too high, patients could also
is a prescription drug that experience bleeding. should be?
lowers the chance of blood
clots developing in the body. A typical INR score ranges First, always listen closely to
This prevents blood clots from between 2 to 3. The “ideal” INR your doctor’s instructions.
forming and causing deep vein score can vary from patient to Patients on warfarin may have
thrombosis (DVT), pulmonary patient. their dosages adjusted often,
embolism (PE), stroke, heart as doctors look to stabilize their
attack, and more. Warfarin How often is testing INR levels. Always be sure to
works by blocking the formation stay on top of your medication
of vitamin K-dependent clotting needed? and to take it exactly as your
factors, substances in the blood doctor prescribes. For example,
that cause clotting. How often a patient should if you miss a dose, don’t
be tested can vary, depending double up next time you take
While warfarin’s ability to stop on how stable their INR level it. It is also key to ensure your
clotting is a major benefit to is over time. According to the doctor knows about all of the
blood clot patients, it can American Heart Association other medications you are on,
also cause problems. If it is (AHA), patients should be tested as different medications can
too effective at stopping the at least once a month and, in interact poorly with warfarin.
clotting process, it can lead to some cases, as much as twice a
uncontrolled bleeding. In order week. This testing often involves When you are at the doctor’s
to monitor how effective the going to get their blood drawn office, the information they give
warfarin treatment is, doctors at a clinic, but can also be done you can often be overwhelming.
test a patient’s “INR” level. at home in some cases. Try bringing a notepad and a
pen. Write down what your
What does INR stand for? Home testing involves patients doctor tells you to ensure you
using an INR monitor and test aren’t forgetting anything. This
INR stands for International strips. Patients are taught how is also a great way to remember
Normalized Ratio. to test their own INR level and your questions. If you write them
then report their INR results to down in your notepad before
Doctors measure a patient’s their care team, who can then heading to the doctor’s office,
INR level during a PT-INR test. tell patients if they need to you’re less likely to forget.
The PT stands for prothrombin adjust their warfarin dosage.
time. The test measures how A second major thing patients
much time it takes for a patient’s If you are interested in exploring need to watch is their diet.
blood to clot. This test ensures home testing as an option for When you are on warfarin, you
that patients are receiving the your care, talk to your doctor need to keep track of foods that
dosage of warfarin that is right about your options. may have vitamin K in them.
Because warfarin works by
blocking vitamin K-dependent

PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

A Guide to INR Levels

clotting factors, increasing Looking Forward
your vitamin K intake can make
warfarin less effective, lowering Starting a new medication
your INR level. Foods with high always has its challenges
levels of vitamin K include kale, and warfarin is no exception.
broccoli, and Brussels sprouts. By knowing your INR level
and staying on top of your
Your INR level is complex. In warfarin dosage, you can
addition to vitamin K, any major help maintain a healthy
lifestyle changes can cause lifestyle.
your INR level to change. These
can range from changing what
foods you eat to how much you
exercise. Major diet changes,
such as starting a new diet
or taking new supplements,
can cause your INR level to
fluctuate. Consulting a doctor
is the best way to ensure the
lifestyle changes you’re making
will positively impact your life.

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Just Relax: The Science Behind Using Meditation
to Combat Stress and Improve Your Health

S tress. It’s something that “There have been a lot of “Mindfulness is typically
everyone deals with in their studies done on mindfulness associated with all of the
lives, but too much of it can be and stress,” remarked Jonathan biological aspects of stress
unhealthy. It can lead to heart Greenberg, PhD, a Postdoctoral reduction, such as a slower
disease, insomnia, high blood Research Fellow in the Lazar breathing rate and lower
pressure, and more. Lab at the Department of blood pressure,” explained Dr.
Psychiatry at Massachusetts Greenberg. “It also corresponds
“The stress response, in and General Hospital and Harvard with brain changes that we
of itself, is not a bad thing,” Medical School. The lab where see. The amygdala (which
explained Dr. Darshan Mehta, Dr. Greenberg works studies the is involved with emotional
Medical Director at the Benson- impact of yoga and meditation processing, fear, threat, and
Henry Institute for Mind Body on brain structure and anxiety) is one example. When
Medicine at Massachusetts function, as well as cognitive we’re afraid, the amygdala
General Hospital. “It was performance. “One of the most is over-activated. Individuals
important for our survival as well documented effects of undergoing mindfulness
the human species. If there was mindfulness meditation is that it training have been shown to
an imminent danger in front of reduces stress. The most well- have reduced amygdala activity
us, we were able to muster up known and widely used form when confronted with stressors.
resources in a short amount of of mindfulness intervention is They have also been shown to
time. This became known as the called ‘Mindfulness-based stress return more quickly to baseline.
fight or flight response.” reduction.’” If something stressful occurs,
your amygdala activity goes up
“Over the past 40 years, Meditation and because you’re very stressed,
we’ve learned that when but the amygdala activity
that response is chronically Mindfulness Magic returns to its former relaxed
activated, the consequences state quicker in those attending
are contributing factors to a Meditation and mindfulness mindfulness training.”
whole host of conditions, such have been found to provide
as hypertension, respiratory many benefits for those who “One of the studies in our lab
conditions like asthma, and practice them. Mindfulness is has shown that reductions
inflammatory bowel disease,” he when participants “live in the in grey matter density in
stipulated. Patients managing moment” and are aware of how the amygdala following
chronic illnesses, such as blood they’re feeling, emotionally mindfulness training correlate
clots, are especially at risk for and physically, and what they with reductions in stress. That
being stressed and anxious. are thinking. It is a way of means that the more people
They are often balancing the living, versus meditation, which reduced their stress, the smaller
responsibilities of their jobs and involves practitioners taking their amygdala became,”
families, while also trying to time out of their day to practice. Dr. Greenberg continued,
manage their disease. explaining the effects that
Both can affect how the body mindfulness and meditation can
So how do people manage responds to stressful situations have on the brain.
stress? For many, meditation and can even change how the
and mindfulness are the answer. brain develops.

PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Just Relax: The Science Behind Using Meditation to Combat Stress
and Improve Your Health

“One of the main things thought leaders in the field,” Working Meditation into
related to mindfulness training Dr. Mehta explained. “It’s this
is improvements in emotional counter-stress physiology that Your Life
regulation. Because you practice can mitigate the negative effects
noticing what you feel and what of the stress response when it is Could you use some stress
you think, you’re better able chronically activated.” reduction in your life?
to nip the emotion in the bud.
So, once the stress begins, you The relaxation response affects Give meditation and
realize it really quickly and are the body on an epigenetic level mindfulness a try. While
able to regulate it and prevent it and on a physical level. there is no right “dose”
from escalating into a full blown of meditation, Dr. Mehta
stressful reaction.” “As a clinician, I like to think recommends that people try
of three dimensions that the to practice 10-20 minutes
“Fight or Flight” Vs. relaxation response would of meditation daily. “It’s
affect,” said Dr. Mehta, like brushing your teeth, it
“The Relaxation Response” exploring the ways that the should be an activity of daily
relaxation response can help living,” he explained.
Stress is an evolutionary patients coping with chronic
mechanism that developed illness. “One, it affects the He also recommends people
to help keep people safe. manifestation of symptoms, such find a group to participate
When the brain perceives a as fatigue, sleep disturbances, in. “I think having guidance
“threat,” the central nervous and pain. We know that people is important, just like any
system triggers the body’s can affect how they experience skillful practice,” he said.
“fight or flight” response. The these symptoms through the
hypothalamus then releases elicitation of the relaxation “Be persistent,” encouraged
adrenaline and cortisol in order response. The second is disease Dr. Greenberg, offering
to prepare the body to either progression. For example, we advice similar to Dr. Mehta’s.
fight the threat or run away know that the chronic stress “Try to link it to something
from it. This response is helpful response can lead to the that you routinely do every
when people are facing life- progression of diseases such day. It also helps to attend
threatening situations, but many as diabetes, hypertension, or classes, or do it in a group
people experience this response vascular disease. The relaxation session to help you keep it
in reaction to everyday, harmless response can help combat this. active in your mind.”
“threats,” such as long lines, The third dimension is through
traffic, heights, or public management of the condition.” Mindfulness classes and
speaking. meditation groups are
available in cities across
Chronic stress develops when Patients experiencing stress North America. More and
the body stays in this state of are less likely to manage their more, doctors are adopting
“fight or flight” and the central own health and can experience it as a secondary form of
nervous system doesn’t return trouble with self-care tasks, treatment to compliment
to its normal levels. Meditation such as taking their medication medical therapies. Check
and mindfulness help to combat properly, getting enough with your local hospital or
this by triggering the relaxation exercise, and eating a healthy your primary care physician
response. diet. Using the relaxation for recommendations of
response to combat this stress meditation groups near you.
“The relaxation response was can help patients better cope
a term that Dr. Herbert Benson with their health problems.
coined. He was one of the

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PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Yoga: The Medicine You Didn’t Know You Needed

Y oga is an ancient Hindu Embrace the Challenge “We always ask if there are any
discipline that is centered injuries,” said Jennifer. As a yoga
around holding the body in Yoga can be challenging, both instructor, she is there to help
different positions. While doing mentally and physically. each student reach a level of yoga
yoga, practitioners focus on that is personally challenging,
controlling their breathing, “It’s challenging for all different without being overwhelming.
clearing their minds, and reasons,” Jennifer noted. “Some “For everything we do, there
challenging their bodies. It brings people have a hard time being in are accommodations, such as
many people a sense of calm and an environment that’s really quiet, dropping knees, dropping arms,
helps them deal with the anxiety where they’re alone with their changing breathes, or maybe not
and stress of everyday life. own thoughts in their heads, or holding a pose as long.”
listening to other people breathe
Many patients with blood clots next to them, or not being able In addition to accommodations,
are not strangers to stress and to talk. That’s really hard for different types of yoga fit
anxiety. Both can accompany people.” different people’s needs. Hatha
the many unknown factors that yoga is a form of yoga that
come with being diagnosed with Many people avoid yoga because involves slower movements that
deep vein thrombosis (DVT) or they tell themselves that they can be gentler on the body.
pulmonary embolism (PE). Yoga can’t do it. They may feel like they In comparison, vinyasa yoga is
may be a tool to help these aren’t flexible enough, young more lively and more movement-
patients take back control over enough, or fit enough to practice intense.
their lives. yoga. However, that isn’t the
case. Anyone can do yoga if they At any point, during any type of
“Yoga is like moving meditation. just give it a try. yoga class, students can go into
You get to move and clear your a position known as child’s pose.
head. It’s amazing what an hour “People get confused. They think This is when a person kneels
class gives you after you leave,” that because they’re not flexible on the ground and rests their
said Jennifer Hedstrom, a yoga or they’re older or they’re injured, forehead on their yoga mat.
practitioner and instructor. “It’s they can’t handle the quicker
just a sense of new beginning and pace,” explained Jennifer. “That’s It’s a restorative pose that is
peacefulness. I notice in my own the biggest thing to learn, coming meant to help yoga practitioners
life that I can take a step back and out of the exercise gym world rest.
look at things a little differently.” and into the yoga studio. First
of all, no one cares what you’re The Science Behind Yoga
Jennifer started out as an avid doing on your mat. There’s no
runner. However, after being competition with the person Yoga can help blood clot patients
diagnosed with arthritis, she next to you. It’s just learning to manage their anxiety by causing
needed to find an exercise that listen to your body and not judge actual chemical changes in the
wouldn’t harm her joints. That’s what’s going on around you or brain.
when she started doing yoga. how you feel that day.”
As a teacher, she now helps her It is well known that exercise can
students to embrace both the Although a yoga class can help to improve mood and relieve
benefits and challenges that come have people of different skill anxiety. Research suggests that
with practicing yoga. levels, instructors have ways of yoga could be more powerful at
making the class appropriate for improving mood and relieving
everyone. anxiety, because it leads to an
increase in GABA levels in the
brain.

PREVENTING, MANAGING, & THRIVING WITH THROMBOSIS

Yoga: The Medicine You Didn’t Know You Needed

GABA is a neurotransmitter that can’t be ignored because of the parasympathetic nervous system,
helps brain cells communicate study. according to Dr. Streeter.
with each other. When GABA
levels are low, stress and anxiety “It doesn’t say that yoga is One study that analyzed the
can develop. better than walking,” cautioned effects of yoga in women with
Dr. Streeter, explaining that depression and anxiety found
In a 2010 study, “Effects of the environment could affect that, after attending a two-
Yoga Versus Walking on Mood, the quality of the participants’ month yoga class, participants
Anxiety, and Brain GABA Levels: walk. “When you put people in experienced decreased
A Randomized Controlled MRS a gym and you have them walk levels of anxiety. Researchers
Study,” Dr. Chris Streeter, MD, around at two and a half miles concluded that yoga could serve
associate professor of psychiatry an hour…and you have people as a complementary form of
and neurology at Boston do yoga in the same gym, in that therapy for patients with anxiety
University School of Medicine, environment yoga is better. You disorders.
and her research team explored can’t say that a beautiful walk
this possibility. on the beach is the same. It’s an Blood clot patients who
entirely different animal. There experience anxiety, including
The team compared two groups are different factors involved.” anxiety attacks, can manage it
of participants, with each group better if they have a stronger
made up of healthy people Yoga’s Effect on the parasympathetic nervous system.
with no significant medical or
psychiatric disorders. The first Parasympathetic Nervous Getting Started
group participated in yoga for
60 minutes, three times a week System Finding your local yoga studio
for twelve weeks. The second is only a Google search away.
group exercised the same In addition to raising the
amount, but they spent their brain’s GABA levels, yoga Many studios offer different
time walking. Along the twelve also has a large impact on the types of yoga, geared towards
weeks, researchers measured parasympathetic nervous system, different practitioners’
each participant’s mood and which works to slow the heart needs. Looking to ease into
anxiety at weeks zero, four, eight, and lower blood pressure. The the yoga world? Try a class
and twelve. Participants also slow breathing and meditation geared towards beginners
underwent MRS scans. that comes with yoga is known or a restorative yoga class.
to strengthen the body’s Restorative yoga involves
parasympathetic nervous system. fewer poses and is meant to
be relaxing. Would you rather
The study concluded that, “The A stronger parasympathetic a more physically challenging
12-week yoga intervention nervous system helps balance out class? Try hot yoga, where the
was associated with greater the body’s reaction to stressful room is heated to 80 – 100
improvements in mood and situations, triggered by the degrees Fahrenheit.
anxiety than a metabolically sympathetic nervous system.
matched walking exercise. This is The body’s sympathetic nervous Other forms of yoga include
the first study to demonstrate that system raises blood pressure, bikram yoga, hatha yoga, and
increased thalamic GABA levels heart rate, and blood sugar levels vinyasa yoga. Each is unique
are associated with improved during stressful times. This is also and offers its own challenges.
mood and decreased anxiety.” known as the body’s fight or flight
response. If you think you would like to
“People in the yoga group start practicing yoga or any
reported having increased mood Patients who experience stress- other exercise, consult with
and less anxiety over the course related issues, such as depression your doctor before getting
of the study than the walking or anxiety disorders, usually started.
group,” explained Dr. Streeter. experience an imbalance, where
However, she cautioned that the their sympathetic nervous system
value of other forms of exercise is working more than their

Anticoagulant Comparison Chart

Which anticoagulant is right for me? For more information please visit www.natfonline.org

Brand Name Warfarin Dabigatran Rivaroxaban Apixaban Edoxaban Betrixaban

What is the name Yes No No No No No
of the drug I am
taking?

Generic

Is there a generic
available?

FDA Pre-1982 October 2010 July 2011 December January 2015 June 2017
Approval Warfarin was 2012
first used in The
When was humans in Stroke Stroke Stroke Stroke prevention
this drug first 1954, before prevention prevention prevention prevention of deep vein
approved by the the FDA in non- in non- in non- in non- thrombosis
regulated valvular atrial valvular atrial valvular atrial valvular atrial (DVT) and
FDA? drugs. fibrillation fibrillation fibrillation fibrillation pulmonary
embolism
FDA Stroke Treatment and Treatment and Treatment and Treatment (PE) in
Approved prevention secondary secondary secondary of deep vein hospitalized
in atrial prevention prevention prevention thrombosis medically-ill
For fibrillation of deep vein of deep vein of deep vein (DVT) and patients.
and valve thrombosis thrombosis thrombosis pulmonary
What conditions replacements (DVT) and (DVT) and (DVT) and embolism 40 mg or 80
is this drug pulmonary pulmonary pulmonary (PE) mg capsule
Treatment embolism (PE) embolism (PE) embolism (PE)
approved for? and
prevention VTE VTE VTE
Drug Image of deep vein prevention prevention prevention
and Available thrombosis after hip after hip after hip
(DVT) and replacement and knee and knee
Drug pulmonary surgery replacement replacement
Strengths embolism surgery surgery
(PE)
75 mg, 110 10 mg, 15 5 mg or 2.5 15 mg, 30
Variable mg, or 150 mg, or 20 mg mg tablet mg, or 60 mg
mg capsule tablet tablet

Anticoagulant Comparison Chart, Continued

Which anticoagulant is right for me? For more information please visit www.natfonline.org

Brand Name

What is the name
of the drug I am
taking?

Warfarin Dabigatran Rivaroxaban Apixaban Edoxaban Betrixaban

Dosing Once Daily Twice Daily Once Daily Twice Daily Once Daily Once Daily
Frequency (following a (following (following an
three week a one week inital single
How often loading period loading period dose of 160
do I take of twice daily of 10 mg twice mg, then 80 mg
for PE and daily for PE once daily for
this drug? DVT) and DVT) 35 to 42 days)

Onset Slow: Fast: Fast: Fast: Fast: Fast:
Several Days A Few A Few Hours A Few Hours A Few Hours A Few Hours
How long does it Hours
take for the drug to

be working in my
body?

Kidney Function No Yes Yes Yes Yes Yes
Kidney Kidney function Kidney function Kidney function Kidney function
Should my kidney function affects the affects the affects the affects the
function be affects the dosage dosage dosage dosage
dosage
considered before
starting this drug?

Food Effect Yes No Yes No No Yes
Speak with Xarelto should Few Bevyxxa doses
Do I need to your provider be taken with Few should be
take this drug with about vitamin the dinner No taken at the
food or can this drug K intake meal. Yes same time of
be affected by the and warfarin. AndexXa day with food.
(Andexanet Few
food I eat? alpha)

Drug
Interactions

How many other Many Few Few
drugs may interfere

with the way this
drug works?

Routine Lab Yes No No No No
Monitoring

Do I need to monitor
my anticoagulation
level?

Reversal Agents Yes Yes Yes Soon Soon
(Vitamin K, Fresh Praxbind AndexXa (May use (May use
Are there agents Frozen Plasma, (idarucizumab) (Andexanet Prothrombin Prothrombin
to reverse major Prothrombin alpha) Complex Complex
Complex Concentrate in Concentrate in
bleeding? Concentrates) emergencies) emergencies)