Professor Gordon Lowe : Lots of Clots in Scots
Gordon’s witty title disguised the underlying serious nature of his talk on blood clots, heart disease and related conditions. I am sure when most of the members will remember from their youth that it was infectious diseases which were the major cause of deaths; eg pneumonia, whooping cough, measles, etc and, especially tuberculosis. Few will fail to remember the mass TB X-ray campaigns of the time. In fact looking at the records from the 1900s until 1960, it was infections which were the main killer. Public action to improve housing, water supply and sanitation, not to mention improved medical care, resulted in a steady decline of infections from 1900 to 1960. A progress wrecked by Covid-19 but more on this later.
In the period 1900 to 1970 there was an emerging pandemic of deaths caused by blood clots. In the 1960s infections were overtaken by clot related deaths. These mainly affected the heart, brain, legs and lungs. The vulnerable age range was 40 to 69 and men were more likely to experience them than women. Studies revealed that the Northern Irish and Scots had the highest risk compared with places such as Spain, Italy and Japan. As an interesting aside by this author, does Northern Ireland’s performance reveal one legacy of the Scottish Plantation? In short, by the 1980s Glasgow had the misfortune to be known as the Heart Attack Capital of the world.
Gordon explained the aging process at play in our arteries. Over time with wear and tear there is an increasing risk of angina, TIAs and claudication (called after Emperor Claudius who limped) and if, particularly bad, blood clots cause heart attacks, strokes and death. Throughout his talk Gordon drip fed the fascinating history of blood clot research. This revealed that Glasgow University played a significant part in European research into blood clots from the late 18th Century until the present time. Moreover, as a result of the clotting pandemic in the 1960s cutting edge clinical work was being done in collaboration with Glasgow’s NHS hospitals. This included the setting up of a Haemophilia and Thrombosis Centre at the Glasgow Royal Infirmary. Here they specialised in research, diagnosis and the management of clotting aided by clinical trials. This work was also of great educational benefit for students, staff and sharing with the global health community. As Gordon put it, Glasgow showed the way.
The inevitable question was raised by Gordon, why do we get blood clots? Simply put, it is to stop us bleeding to death. We wouldn’t have survived long as a species if our wounds didn’t heal. It is a complex process starting with platelets sticking to the point of injury which allows the body to repair itself. Unfortunately this ability to clot, or coagulate, despite its benefits, can occur throughout the body triggered by a multitude of things. Studies showed that men were particularly vulnerable if they smoked and lived in deprived communities. Deep vein thromboses, which can lead to pulmonary embolism, we tend to associate with long haul flights, can be caused by immobilisation especially in hospital beds.
So why is it that the Scots are so prone to clotting? Gordon explained that the von Willebrand factor, a protein in the blood, plays a key role in clotting. It turns out that Scots’ blood has more of this factor than in other countries such as Spain and Italy and contributes to our vulnerability. Obviously a great source for continuing and future research between genetics, diet, life style and the environment. What’s important in the mean time, having identified the problems, is getting on with remedies and prevention.
One of the earliest remedies was the drug streptokinase which could be shown to dissolve blood clots. However, another simple one was getting patients back on their feet after a heart attack or an operation because their blood tended to pool in their legs in bed and start to thrombose. The clots formed could then travel to the heart, lungs or brain once the patient got up and started to move about with fatal consequences. Blood thinning drugs such as heparin were used to prevent coagulation. This measure is further aided by stockings, or leg compression, to increase the return of blood to the abdomen. An oral drug, warfarin, interacts with other drugs including alcohol. Clearly an unsatisfactory outcome for medical science and its users. However, as a result of research, a body of drugs have been researched and developed which are not affected by other drugs or alcohol. These are known as DOACs (Direct Oral Anti-Coagulants). These drugs have given clinicians useful tools for use as prophylactics and with which to manage clotting risk when adverse events have occurred. Needless to say, they are also welcomed by the clients because they can still enjoy a drink with food, friends and celebrations!
Of course, Gordon couldn’t avoid observing Covid-19 has spoiled this record of achievement. Covid causes clots throughout the body and the pandemic is leading to a mortality rate from infections not seen since the Spanish Flu a hundred years ago. Risk is aggravated where patients are immobilised for long periods. Covid vaccines are important in bringing Covid under control. Some Covid vaccines are known to increase the risk of cerebral vein thrombosis, but the risk of mortality from Covid is 10 times higher. So the vaccine is worth taking with the caveat, don’t use these vaccines on young people.
Well there you have it, extraordinary progress has been made since 1900. There has been a major decline in infections and diseases. Dramatic progress has been in reducing heart attacks, pulmonary embolisms and strokes since the 1970s. The University of Glasgow and NHS Glasgow have made a major contribution to this success.
Gordon’s talk was followed by a vigorous Q&A session on Glasgow people’s diet, Scottish clotting factors and the impact of Covid on the capacity of the NHS and impact on day to day health. One curious issue emerged. Gordon was asked about the recent advances made in the ability to remove clots causing strokes from people’s blood streams. He indicated progress had been slower in NHS Scotland than in England, but it now finally progressing. Gordon’s final closing message to members, mindful of their demographic, was ‘stay safe, active and medicated’.
This was a brilliant talk on a complex subject. A short blog glosses over much of the detail and doesn’t do justice to Gordon’s detailed explanation of the patient research and steady accumulation of critical breakthroughs made since the early nineteenth century at Glasgow University and elsewhere in Europe. Nor is there space here to name the many Scottish scientists and clinicians in the last 80 years who made inroads to getting clots under control, save to say that Gordon is one of them! However, all Club members now have a clearer appreciation of the wide ranging challenges in dealing with clots, trying to prevent them and, should they occur, managing them. A sterling talk, many thanks Gordon.