Blood Clots and The D-Dimer - Know How To Flow
Anytime we have sliced our hands prying out that avocado pit, picking up broken glass, or that mishap with a hay hook (it’s a long story…) we are grateful for our ability to clot and stop bleeding. But, if clotting happens in a healthy, non-traumatized vein, a potentially life-threatening pathology occurs called venous thromboembolisms (VTEs) or blood clots.
Blood clots are the end result from coagulation, when platelets aggregate (stick together) to make a fibrin-mesh plug. When pieces of these clots break off (embolisms), they can travel to capillaries in the brain, heart, kidney, lungs, or limbs, which can result in stroke, heart attack, pulmonary embolism, all life-threatening. The Center of Disease Control has reported that as many as 900,000 Americans each year are affected by VTE. (1)
Most of the time, these blood clots form in the deep veins of the pelvis, lower leg, and thigh - in which they are called Deep Vein Thrombosis (DVTs). The ominous signs of a DVT are swelling, pain, redness of usually one leg. Medical care should be sought immediately if you even suspect you have this and imaging and treatment measures need to be sought urgently.
Risk factors for making VTEs include being immobile (long car or plane rides), obesity, smoking, taking oral birth control pills, not exercising, having cancer, and enduring a long surgery. Once you have had one VTE, you are at high risk for forming these again. Other than the lower leg swelling, unfortunately few other symptoms or signs exist for letting you know about VTEs.
Diseases like atherosclerosis (hardening of the vessels), cardiac arrhythmias and blood clotting disorders like Factor V Leiden and antiphospholipid syndrome pose increased risks for VTEs. Even the COVID-19 infections have been shown to increase risks of blood clots. (2)
Fortunately, a simple, inexpensive blood test exists that can help you track the formation of these clots - the D-Dimer. If you have increased risk factors, the D-Dimer is vital. When a blood clot begins to dissolve, D-Dimer (a protein) is released. It is named for the two “D” shaped fragments that make up its structure. The presence of the D-Dimer confirms that thrombin and plasmin formation has occurred and a clot exists, somewhere. (3)
A normal D-Dimer is less than 0.4 mcg/mL (or mg/L) or 250 ug/L. Most labs will report the mcg/mL, but watch out for those units or you can misread this. There are few ways a D-Dimer can be false positive - rheumatoid factor (a blood test that confirms rheumatoid arthritis), CA-125 (a tumor marker for ovarian cancer), and various estrogen therapies and even the estrogen elevations in pregnancy all can give a false positive. A D-Dimer will also usually be positive after surgeries and traumas, due to the normal healing of tissues. (4)
D-Dimers can be run at any medical doctors office or lab center. The cost is around $30 (not counting the draw fee). If you have a positive D-Dimer and any of the risk factors, it is vital that you seek medical attention for imaging and treatment due to the risks for stroke and heart attack.
However, if life-threatening circumstances have been ruled out by your healthcare provider, supportive measures exist to help dissolve the clot. First, move. Exercise promotes circulation and this will support the body’s natural progression for dissolving the clot in a balanced way. People often get really concerned about moving because they think that will break the clot loose for the embolism event; that really isn’t how that works. When the clot gets too big, it is more likely to break off due to the size. Exercise will promote circulation (provided there is no trauma) and will actually dissolve the clot. (5)
In addition to exercise, a few supplements have been reported to be supportive for dissolving blood clots.
Grape Seed Extract has been studied in respect to coagulation time, clot formation, and clot firmness to be “a promising nutraceutical in the prevention of cardiovascular thrombotic events caused by different mechanisms”. (6)
Bromelain is an enzyme from pineapples that breaks down blood clots and reduces clot formation. It also has anti-inflammatory properties that improve blood viscosity (making it less sticky). (7) However, if someone has a pineapple food allergy, bromelain may create inflammation, so this has to be watched.
Two very powerful and promising proteolytic enzymes have surfaced in the last few years that show great results for dissolving blood clots - Nattokinase and Lumbrokinase. Nattokinase comes from nattō, fermented soybean common in Japanese foods. This enzyme can degrade fibrin and plasmin, substrates involved in clot formation. It also decreases the activity of clot-forming components in the blood (plasminogen activator inhibitors) and increases the level of things that dissolve clots (plasminogen activators). (8)
Lumbrokinase is even more potent than nattokinase. Lumbrokinase is a fibrinolytic enzyme isolated from earthworms. Earthworms secrete this to be able to burrow through soil effectively. Bulouke is the brand name of the lumbrokinase commonly used. Because it just targets fibrinogen and fibrin (blood clot components), it will work well with medications for bleeding disorders like coumadin or heparin. No earthworms are harmed in the process of extracting lumbrokinase - it is extracted from their soil.
Balancing out the clotting cascade to stop VTEs can be done effectively by supplementation and working with your healthcare provider. The beauty of Grape Seed Extract, Bromelain, Nattokinase and Lumbrokinase is that they pose less of a risk for increasing bleeding times, meaning if you cut yourself, you won’t bleed excessively while taking these supplements.
These supplements can be taken with various medications. But, to be sure that clotting is being managed well, the tests PT and INR are useful tools. These track your clotting time. PT stands for Prothrombin Time and measures how long it takes your blood to clot through the common coagulation pathways. Normal range is 11-13.5 seconds. INR is the International Normalized Ratio is a more standard version of the PT. Normal INR is 1.0. (9) Whenever there is a question about the supplement interaction with the medication, tracking the PT and INR gives us the info we need to stop or adjust the plan.
Blood clots are frightening to think about. But, arm yourself with information so that you can be guided through the healing path. With proper support, healthy habits, and careful testing blood clots can be successfully resolved.
Bounds EJ, Kok SJ. D Dimer. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431064/
Fischbach FT, Dunning MB. A Manual of Laboratory and Diagnostic Tests. 8th ed. Philadelphia, NY: Williams & Wilkins; 2004.
American Heart Association's 4th Annual Conference on Arteriosclerosis, Thrombosis and Vascular Biology, Washington, D.C., May 8-10, 2003. News release, American Heart Association.
Bijak M, Sut A, Kosiorek A, Saluk-Bijak J, Golanski J. Dual Anticoagulant/Antiplatelet Activity of Polyphenolic Grape Seeds Extract. Nutrients. 2019;11(1):93. Published 2019 Jan 5. doi:10.3390/nu11010093
Pavan R, Jain S, Shraddha, Kumar A. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:976203.doi:10.1155/2012/976203
Weng Y, Yao J, Sparks S, Wang KY. Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease. Int J Mol Sci. 2017;18(3):523. Published 2017 Feb 28. doi:10.3390/ijms18030523