University of Vermont

Cushman Comments on Hillary Clinton’s Cerebral Blood Clot

U.S. Secretary of State Hillary Rodham Clinton
U.S. Secretary of State Hillary Rodham Clinton

Internationally-recognized for her expertise in the field of thrombosis – blood clots – and cardiovascular risk factors, University of Vermont Professor of Medicine Mary Cushman, M.D., M.Sc., was quoted in a recent article about the brain blood clot suffered by U.S. Secretary of State Hillary Clinton in December 2012.

Cushman, who also serves as director of the Thrombosis and Hemostasis Program at Fletcher Allen Health Care, explains that Clinton experienced a cerebral vein thrombosis. “This occurs when blood coagulates to form a clot inside one of the veins that drains blood from the brain in order to bring it back to the heart,” says Cushman. Symptoms often include headache, vomiting, and seizures. “If the clot is large enough or persistent, other neurologic impairments like visual disturbances and focal weakness can occur,” adds Cushman.

This type of blood clot, which Cushman says is relatively rare, accounts for about one percent of all strokes and can be triggered by such factors as birth control pills and pregnancy, but often occurs without a precipitating cause. Some people possess a genetic condition that predisposes them to develop blood clots in their leg veins – called deep vein thrombosis – or lungs – referred to as a pulmonary embolism – and also increase the risk of cerebral vein thrombosis (CVT). Reports stated that Clinton experienced a deep vein thrombosis in 1998, but it is not known if she has a genetic condition.

“These conditions are present in about seven percent of healthy Caucasian individuals, so are common risk factors for thrombosis, including CVT,” Cushman says.

To treat a CVT or other blood clot, specialists immediately administer an anticoagulant (blood-thinning medication), which halts the growth of the blood clot. In most cases, shares Cushman, the body naturally heals the clot. To prevent a CVT recurrence, the blood-thinning treatment is given for at least three to six months, and often longer depending on the individual’s circumstances. Once treatment is discontinued, these patients remain at risk of deep vein thrombosis, pulmonary embolus, and sometimes CVT, so require education about these disorders and prevention measures as well.

“In the Thrombosis and Hemostasis Program at Fletcher Allen, we pursue tailored acute and long-term treatment for each CVT patient in collaboration with the stroke neurology service,” says Cushman. “This treatment is guided by their clinical history and often by whether or not they have an inherited tendency to thrombosis.”

In February 2011, Cushman coauthored an American Heart Association (AHA)/American Stroke Association Scientific Statement on “Diagnosis and Management of Cerebral Venous Thrombosis”. Cushman is chair of the American Society of Hematology's subcommittee on quality of care and a member of the AHA Science Advisory Coordinating Committee, chair of the AHA Council Operations Committee, and president of the Vermont AHA Board of Directors.