Bleeding and Clotting!
Two sides of the same coin. When people are more prone to bleeding, there is often an abnormality of the clotting system. Many innate deficiencies of clotting such as Hemophilia are severe before being recognized. There are many other rare inherited disorders of bleeding and clotting. Some people are more prone to clotting and these patients get started on blood thinners.
Increasingly, we are seeing more patients with bleeding problems, partly because the mainstay of many cardiovascular treatments include some kind of blood thinner. It could as simple as a "baby aspirin", a combination of Aspirin and Clopidogrel/Aspirin and Ticagrelor (Dual anti-platelet therapy or DAPT), warfarin (Vitamin K antagonist) or some of the New Oral Anticoagulants (such as Apixiban, Rivaroxaban, Dabigatran, etc).
Abnormal dynamics of the flow of blood in and close to the heart such as a narrowed heart valve can cause derangements in the levels of von Willebrand factor (vWf) which is a large protein close to Factor VIII. Both of these large proteins are very intimately connected to the clotting mechanism. Abnormalities in them and changes in their levels usually provide clues to a predilection to bleeding. Excitingly, we have been able to detect and quantify von Willebrand factor using our Spectroscopy methods in our Spectromix Lab. This is very exciting because it might change the way we evaluate bleeding conditions. This then provides us with the mechanistic understandings of how vWf changes with changing flow conditions.