It's not his height. Some people have blood that is just prone to clotting because of certain inherited genes. Then there are autoimmune causes like people with Lupus anticoagulant.
Unfortunely Leiden is very common. At least in Europe. 5-10% of the general population are estimated to be heterozygotous to the gene. It requires a trigger to happen, it's not that you will develop clot while doing nothing. (if you are heterozygotous). That's why IF you have a family member who has ever developed a clot, you MUST make sure to make your doctor aware of it, so in case of a surgery or if you give birth to put you on blood thinners. Because genetic tests are not only expensive but hard to do, the solution is that as the best precaution. Know your family history.
I don't remember him saying it. There are many genetic causes. Like 15+. Let's just say a recurring blood clot, puts a genetic cause as a huge no.1 in the differential diagnosis and leave it at that. I hope it ends up being not a blood clot.
He said he doesn't have any genetic predisposition to it. He got tested: http://www.sun-sentinel.com/sports/miami-heat/sfl-miami-heat-chris-bosh-092415-story.html So what the hell is going on? Is this simply two freak accidents? Shocking luck?
Dude needs lifelong anticoagulation. No way around it. Just because you test negative for the common hypercoagulable disorders, it doesn't change the clinical approach. If this is a second clot, then he needs to retire.
Yeah I thought it too, but he's not a normal patient. A normal person wouldn't have the means to test for all the genetic disorders but a millionaire and pro athlete like Bosh will. Good news. If has excluded ALLl genetic causes then you move down in your DD and look for example at lupus , Crohns, perhaps heparine reaction etc. I guess Bosh's doctors have already excluded those. In which case it's probably due to immoblization.. I dont' know I'm not a human doctor and this is a special case. If it was a normal case of a normal human the solution would be much more simple. Almost for sure a genetic cause rare or not, and Cumarin for years.
No. It doesn't matter. From a clinical perspective, testing negative for every known hypercoagulable disorder means nothing. This is per international heme guidelines. The thinking is that there are unknown or currently untestable hypercoagulable conditions that a patient may have. To be honest, even after one unprovoked vte, you can make an argument for indefinite anticoagulation. More recent recommendations are to check d dimer after several months off anticoagulation to further guide duration of therapy. But two episodes is clear cut lifelong blood thinners.
Thanx for your input. Repped. Very interesting. After all a lot of the conditions were relatively recently discovered. (btw here in Greece lately they have been recommending to stop blood thinners after the patient is for 10+ years of good results without any episode.)
This is getting kind of scientific, but let's see where it takes us. As you pointed out, the Leiden syndrome is relatively common in European populations. However, it is rare in African-Americans (Bosh and the majority of NBA players) and almost non-existent in Asian populations. Not all Leiden positives (genetically) develop clots. The chance of normal population for blood clots is about 1:1000. In heterozygote Leyden carrier the occurence rises to 4-8:1000, but in homozygote to about 80:1000. It seems to me that, statistically, to have a homozygote NBA player among a total of 450 NBA players, he should at least be white (like Varejao, Teletovic etc). The mutation, by the way, is a SNIP and, therefore, not difficult to test by PCR.
Yea, and its not like he lives a sedentary lifestyle. Something going on causing him to remain in a hypercoaguable state. Dude probably needs to be on Warfarin for the rest of his life meaning ---> no trauma sports. Sad to say, but at least it will keep him alive and he's earned enough money to live a good life.
This is correct. Leiden is a relatively common allele for Factor V, but the vast minority actually have clotting problems. In his case, it may either be anatomical, or idiopathic. I'm sure they did a battery of genetic and autoimmune tests. At any rate, the poster above is correct. The correct decision is lifelong anticoagulation as a second pulmonary embolism may very well be fatal. I wish Bosh the best, it's tragic he's having such a good year and this happens again.
The decision to stop blood thinners isn't based on great evidence. None of the evidence for duration is particularly great, in fact.
(Didn't know about African Americans). Leiden is JUST one. There are many many more other genetic causes. It's just Leiden is the first suspected because of how common it is. And as for testing I really don't know about the USA. But I suspect he average Joe (not Bosh) doesn't have the ability or means to do genetic testing out of the blue , that's why it is crucial if you have a family history of a blood clotting to let your doctor know. Perhaps in america it is cheap and easy everwhere to do it. Here it isn't. You must go to a specific lab. *shrug*. As for occurence if you are heterozygote it means after birth or a surgery you have elevated risk of blood clotting. Maybe it doesn't happen in one surgery but after years when you have another. Your doctor must know to put you on blood thinners. Otherwise you may put on serious risk.
For homozygous Factor V Leiden yes. For heterozygotes, usually not unless they have a clot. The genetic tests here can be covered by some, but not all, insurance carriers if someone has a recurrent clot. Usually requires a lot of phone calls.
Interesting, thanx Bulkatron. Because I also knew about life long, lately when I learned about it I was alarmed but I thought it was the latest recommendation. (I have a family member who has Leiden). Now you make me worry.
The science is fuzzy because the number of people that can be studied are so small. But it's probably true that 10 years enough, as the risk of recurrent clot is likely to be much lower than adverse events from anticoagulation. Just saying that there's not any landmark studies in this area.
<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">Chris Bosh will reportedly meet with doctors Thursday to determine if blood-clot scare will keep him out for season <a href="https://t.co/of645hGNEt">https://t.co/of645hGNEt</a></p>— Bleacher Report NBA (@BR_NBA) <a href="https://twitter.com/BR_NBA/status/699608238204022784">February 16, 2016</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script> <blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">Agent Henry Thomas tells Sun Sentinel, "It is too early" for any definitive reads on what might happen next with Chris Bosh.</p>— Ira Winderman (@IraHeatBeat) <a href="https://twitter.com/IraHeatBeat/status/699611521232592896">February 16, 2016</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
Height exacerbates the hereditary problem by the longer travel distance for CO and (venous return). That is a fact. In taller people blood must be pumped longer distances by the calf muscle pump. This can reduce blood flow and contribute to clots.
