Left Atrial Thrombus Despite Anticoagulation: The Importance Of Homocysteine

Shannon alertyed me to this report from JAFIB . It is especially noteworthy and refreshing to see that someone is actually interested in monitoring homocysteine levels… which we have mentioned here for a very long time as one of the critical markers to test regularly to insure that you avoid the sticky blood tendency and adverse clotting.

You may have to insist and possibly pay an additiional cost, but it's a life-saver and well worth knowing where you stand with homocysteine and then taking the nutrients involved to reverse it.


Left Atrial Thrombus Despite Anticoagulation: The Importance Of Homocysteine
J. David Spence M.D., FRCPC, FAHA
Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University.

Abstract
Patients in atrial fibrillation may have left atrial thrombi or strokes despite adequate anticoagulation. It is important to consider elevated plasma total homocysteine (tHcy) as a treatable clotting factor that may explain such cases. Metabolic B12 deficiency is common even in patients with a abnormal serum B12. Measurement of holotranscobalamin, methylmalonic acid or, in folate-replete patients, tHcy are necessary to diagnose metabolic B12 deficiency when the serum B12 is below 400 pmol/L. Elevated tHcy quadruples the risk of stroke in atrial fibrillation, and is far more common than the usual clotting factors for which testing is commonly performed: among patients attending.

Introduction
The recent case report by Florea et al.₁ answers a question that has arisen from time to time in my secondary stroke prevention clinic, when a patient in atrial fibrillation (AF) who appears to be adequately anticoagulated has a recurrent stroke. It becomes necessary to reconsider the cause of stroke, because we tend to assume that anticoagulation is effective in preventing stroke in AF.

I have thought in the past that most of these cases were due to an unrecognized period of low INR, during which a thrombus formed, with insufficient time for the thrombus to dissolve when the INR rose again to the therapeutic range. However, I have also seen this problem in patients anticoagulated with the new oral anticoagulants (dabigatran, rivaroxaban, apixaban).

An issue that should be considered in such cases is whether the patient may have a high plasma level of total homocysteine (tHcy), which increases the formation of red thrombus in the setting of deep vein thrombosis, retinal vein thrombosis, cerebral vein thrombosis, and quadruples the risk of stroke in atrial fibrillation2,3

Read the full report [www.jafib.com]

Jackie

This is an important topic Jackie and glad you posted it. Interestingly, at the large BHRT ( BioIdentical Hormone replacement therapy) conference I was working at here in Boston the last four days and just finished up several hours ago, there was a lot of discussion in the two key factors of insuring proper methylation of vital nutrients and hormones via functional enzymatic action and full assimilation as well as the key importance of addressing systemic inflammation for overall health and, of course not just limited to ... But particularly relevant for... Cardiovascular issues including AFIB as we all know so well by now.

An interesting now formula was offer by Nutraceutical maker 'Nu-Medica' called 'Neuro Methylation Cream' its tge new enhanced formula version that has a patented topical application base if 5MTHFolate, P5P (methylated form of B6) along with two methylated forms of B-12 and all in a synergistic base of 2,000iu of Vitamin D3 per two small pumps of cream.

This bypasses all the major loses in the digestive track for such critical B vitamins that plaque so many ficus without realizing it such that so many really need to take huge oral doses of these same methylated forms of Folate, B6 and B12 to even come close to the bio available cellular amount delivered by this topical preparation in just several pumps or drops of this bright red cream.

Was created and patented by a well known Neuro- surgeon in Austin Texas who spoke if how many times he opens up people's skulls only to find lack if methylation and too much inflammation as the core problem these people are dealing with and most would never need brain surgery if they just took care if these two aspects of their everyday nutritional supplemental routine and eating a low inflammation high methylation encouraging diet!

Very convincing and powerful evidenced based documentation and studies prove the point , though Big Pharma isn't so big on this as its hard for them to patent the best solutions, which are natural, to these fundamental issues.

Anyway, for the many if us who lack the fennec or two needed for proper methylation thus new product is the next best thing to full IV of IM injectable pre- methylated co- enzyme B vitamins.

Check out Neuro-Methylation Cream

I'm flying early tomorrow, Sunday morning, to San Fran from Boston to get my TEE at 11am Monday as my Lariat follow up. Will get the final verdict from Dr Natale when aI meet with him on Tuesday afternoon and will keep you all posted.

Take care. Shannon

Of interest:

[www.ncbi.nlm.nih.gov]

But, see:

[www.ncbi.nlm.nih.gov]


I'm still on Pradaxa so does not allay my stroke fear.

Stephen

All the more reason to get an ablation.................

Hi Jackie,

Please could you recommend what you consider to be the best oral supplement to combat homocysteine? I see various options from Jarrow, Now and Source Naturals, but, as usual, am unsure which is the best to go for and as such am reverting to you for your sage advice!

The purported fact that high H quadruples stroke risk really caught my attention - AF or no AF.

Hoping you are well,

Mike F.

Shannon - Thanks for the latest news... the 'red cream' looks to be very efficient.

Mike - I'll post what is in my B regimen that keeps my HCY numbers where they need to be... however, it's multiple caps...so the cream Shannon mentions could be a great substitute... depending on cost and availability.

McHale - Just keep in mind that ablation does not reverse elevated homocysteine or any of the other metabolic dysfunctions that contribute to adverse clotting. You don't have to be in afib to have a clot form as a result of thick, sticky blood that is driven by multiple factors... silent inflammation being a big player.

We still need to monitor all of the influencing factors and typically, that's what we have to insist on having tested unless we are in the care of a Functional Medicine practitioner who recognizes the need to monitor the risk factors for stroke and heart attack.


Jackie

I don't have access to JAFIB.

Is the 5-methylfolate (Metafolin) supplement recommended? I can't tolerate B vitamins but I can take Metafolin.

I have 2 MTHFR mutations.

Jackie, what is "thick, sticky blood"? Is that a particular condition or are you referring to normally clotting blood?

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Shannon,

Thank you for alerting us to the "red cream". Looks like a good way of getting the B-vitamins into the system. However, I believe there is still some controversy as to whether lowering homocysteine level with oral supplementation actually reduces the risk of stroke and heart attack.

[www.ncbi.nlm.nih.gov]
[www.ncbi.nlm.nih.gov]

I guess the question is: "Is a high homocysteine level just a marker of something that increases risk of cardiovascular events or is it an actual cause of such events?"

Any comments on this?

Hans

Mike - You asked about the supplements I use for managing safe Homocysteine (HCY) levels.

I use a combination B complex product, a Homocysteine lowering complex, a L-5-MTHF product and separate B12.

Some years ago, testing indicated I was low in vitamin B 12 so I had injections weekly for about six weeks. Since then, continue to supplement with 5,000 mcg B12 now available in the highly-bioavailable form of sublingual lozenges. The B12 is important because if you are deficient, then the folate supplements aren’t effective.

The brand I use is a professional grade product from Designs for Health, but you can compare their labeled ingredients to those products you find available to you. A couple of notations are important.

1. Folate rather than Folic Acid….You’ll often see Folic Acid on the label and it’s now known that the preferred form is Folate…(NatureFolate® blend) rather than the folic acid. Many brands have not yet made that switch, although it was in the news at least 3 years ago.

Folate is involved in neurotransmitter synthesis and critical enzymatic reactions throughout the body. Not everyone can convert folate to its biological, active form called 5-methyltetrahydrofolate (5-MTHF) Research shows that a large proportion of the population has a genetic enzyme deficiency that facilitates the conversion and are vulnerable to low blood folate levels (and higher-than-desired homocysteine.) Source: Life Extension.. The bioactive form of folate is up to seven times more bioavailable than folic acid and is especially important for those with the genetic deficiency.
Therefore… I take separate capsules of 5-MTHF just to be sure.

2. B6 in the Pyridoxine HCl and Pyridoxal 5-Phosphate is most effective.

3. B12 should always be the Methylcobalamin form

My regimen is
B Supreme – 1/day
Homocysteine Supreme – 2/day
L-5-MTHF – 3 – 4 /day
SubLingual B-12 – methycobalamin – 5,000 mcg daily in 1 lozenge

Always take your B’s in the morning with food, since taking on ‘empty,’ can cause stomach upset in some people…and also if taken later in the day, can be stimulating and interfere with sleep.

The links to compare labels for the products I’ve listed is from Rockwell Nutrition…These are useful because of the detailed product data info also provided. Just use this as a guide when you do your search online. I am partial to products by Natural Factors if any of those come close to similar ingredients.


[www.rockwellnutrition.com]
[www.rockwellnutrition.com]
[www.rockwellnutrition.com]
[www.rockwellnutrition.com]

Hope this helps.

Jackie

Iatrogenia - No... not normal clotting. Thick, sticky blood is also referenced as hyper-coagulable or that with the property of hyperviscosity.

It's caused by a variety of factors including inflammation and various toxins, cellular debris that gunks up blood, lack of proper hydration, too much glucose and so on as outlined in many posts but this one specifically calls out the need to know your markers. As I've said frequently, most people including afibbers don't have a clue as to what their markers actually are because the majority of doctors don't test for them or worse, don't think they are important. It's just good preventive health to know your markers and correct what is out of range.

Thick Sticky Blood and risk of Stroke and MI... posted a year ago at this link:
[www.afibbers.org]

Also...Take note of the effects of grounding or earthing on helping to keep blood viscosity lowered.


Jackie

Hans - The books on Methylation…First, of course (The Homocysteine Revolution), by Kilmer McCulley MD who was drummed into oblivion because his scientific findings on methylation abnormalities didn’t ‘fit’ with conventional thinking tell the Homocysteine/methylation story… Dr. McCulley is now more than exonerated for daring to be brilliant and think outside the (dogma) box..and the followup by Craig Cooney ( Methyl-Magic) tell the story about the importance of identifying aberrations in homocysteine levels and knowing about Methylation.

Elevated homocysteine (and other markers) signify inflammation and is contributory to heart problems and the thick, sticky blood that causes blood platelets to clump and cause the adverse clotting that brings on TIAs, strokes, and heart attacks. Elevated blood viscosity or hypercoagulability is a definite risk factor whether or not you have Afib.

For those not reading when we were talking about Methylation… do a search here for past posts…. Use all dates as it was back a number of years.

Here’s a Google search on elevated homocysteine and blood clots [www.google.com]
58,000 results

The Homocysteine Revolution: An interview with Dr. Kilmer McCully
By Richard A. Passwater, Ph.D.
McCully: As we understand it at the present time, homocysteine is involved in virtually all of the pathogenic processes that result in arteriosclerotic plaques. It is crucially involved in blood clotting. Blood platelets, the smallest cells in blood, are a major factor in the clotting process. When clots form in a coronary artery the blood supply to the heart itself is reduced or stopped. This is called a coronary thrombosis which results in the death of heart tissue which is called myocardial infarction. Homocysteine in its reactive form, homocysteine thiolactone (see figure 3), affects the reactivity of platelets and is extremely active in causing platelet aggregation which can lead to clot formation. When freshly synthesized in test tube experiments, this form of homocysteine causes aggregation of normal human platelets. [www.drpasswater.com]

See also
[www.drsinatra.com]
[www.drsinatra.com]

Jackie

Life Extension has interesting report on lowering homocysteine. See [www.lifeextensionvitamins.com]. The report mentions a number of cases where high homocysteine was dramatically reduced using large doses of Trimethylglycine.

Josiah

I have been taking Metanx 2x/day because of mild peripheral neuropathy; it is a tad expensive and needs an rx (my podiatrist orders this). My endocrinology ARNP also recommended this.

Each tab has:

L-methylfolate (Metafolin): 3 mg
Pyridoxal 5'-phosphate: 35 mg
Methylcobalamin: 2 mg

I also take Biotin and an extra sublingual B-12.

Maybe I am helping to prevent some additonal problems --I sure hope so!!

Karen

Josiah.... yes TMG is an important nutrient and it's included in the complexes I use.


Karen - you can also look into the use of high dose R-Lipoic Acid. . In doses of a minimum of 300 mg daily and typically as much as 600 mg... it's highly effective for peripheral neuropathy...especially in the feet.

[www.lef.org]
[www.lef.org]

Jackie

Hey, thanks Jackie
I've been taking ALA for years but now will check out the R-LA----just read a short essay on it--sounds much more useful than the ALA (although I credit the ALA for yrs and yrs in helping things not get worse)

oops had to edit the original post to say what I meant to say

Karen



Edited 1 time(s). Last edit at 09/28/2013 07:12PM by Kakora.

Jackie,

Thank you for this very informative reply. So it would seem that homocysteine is both a marker of inflammation (as per Dr. Sinatra) and a causative agent in the development of atherosclerosis.

Hans