By Salynn Boyles
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Reviewed by Michael W. Smith, MD
Jan. 2, 2013 -- Medical experts say Secretary of State Hillary Clinton is extremely lucky that her medical team found the blood clot they are now treating with blood thinners.
The rare clot in a vein between her brain and skull was discovered during a follow-up exam Sunday, weeks after she reportedly sustained a concussion after a fall in her home during a bout of stomach flu.
The experts agreed that Clinton's clot could have threatened her life if it had been missed during the routine exam.
Q & A
Where is Secretary Clinton's blood clot exactly?
The clot is in a vein between her brain and skull behind her right ear. The bleeding was reportedly contained within the vein, and there was no bleeding within the brain, which could have led to stroke or brain damage.
So why was the clot so dangerous if left untreated?
If the clot had grown large enough to cause a major blockage of blood, it could have led to serious swelling and even death, says Keith Black, MD, who is head of neurosurgery at Cedars-Sinai Medical Center in Los Angeles.
"I think Secretary Clinton is very lucky that this clot was caught early and treated early," he says.
How rare are these blood clots?
Blood clots occurring in the legs are very common, especially among older people, but clots occurring in the head are pretty rare, says Jack Ansell, MD, who chairs the Department of Medicine at Lenox Hill Hospital in New York City. Ansell says the clots occur in about 1 in 100,000 people and that women experience them about three times more often than men.
"I would have to assume that if she didn't fall and hit her head this would not have happened," he says.
Secretary Clinton had a previous blood clot in the 1990s. Could the earlier clot be related to the new one?
Both doctors agree that it could. In 1998, when Bill Clinton was in his second term as president, then first lady had a deep vein clot behind her right knee. Some people do have a genetic predisposition to develop blood clots, but it is not publicly known if Hillary Clinton does.
Isn't it dangerous to treat someone who has sustained a concussion with blood thinners?
It is true that brain bleeds are a concern after a blow to the head, and that blood thinners like the anti-coagulant Coumadin (warfarin) increase the risk for bleeding. But Black says Secretary Clinton's brain has undoubtedly healed enough in the three weeks since her fall to allow safe treatment with the clot-targeting drugs.
"At this point enough time has elapsed between the fall and the use of blood thinners so that I would not worry about this," he says.
What's next for Secretary Clinton?
Both doctors expect her to be out of the hospital as soon as her blood-thinning medications have been regulated, and she will be followed closely by her medical team while she is on them. That could be a few months or longer. After that, both doctors say she should require no further special medical care involving the clot.
"I would expect her to make a full recovery," Ansell says.
SOURCES: Jack Ansell, MD, chair of the Department of Medicine at Lenox Hill Hospital in New York City. Keith Black, MD, head of neurosurgery at Cedar Sinai Medical Center in Los Angeles.
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