Our Titans of Thrombosis series honors advocates and experts in the thrombosis field and showcases their important contributions.
Dr. Elaine Hylek is a Professor of Medicine at the Boston University School of Medicine and the Director of the Thrombosis and Anticoagulation Service at Boston Medical Center (BMC). She oversees a busy internal medicine practice at BMC and is also an active researcher, focusing on safe anticoagulation and stroke prevention in atrial fibrillation (Afib). She currently serves on the executive steering committee for several clinical trials and for World Thrombosis Day. Dr. Hylek has worked tirelessly throughout her career to educate patients and clinicians about blood clots, stroke risk in Afib, and anticoagulant management. Dr. Hylek recently shared some reflections with us from her 25 years in practice.
Q: Tell us a bit about yourself.
Well, I grew up in Pittsburgh and went to the University of Pittsburgh Medical School and then came to the Massachusetts General Hospital (MGH) for my internal medicine training. I really love the Boston area, and I’ve stayed here since my training. I’m now a Professor of Medicine at Boston University. One of the things that I most enjoy is my patient practice. I think caring for patients is a terrific way to give back to my community.
Q: As an internal medicine physician, how did you become an expert in the thrombosis field?
My path was unique. I started out as a medical technologist and was working in a hematology lab. I got a bachelor’s degree in medical technology and working in the lab exposed me to a lot of interesting aspects of bleeding and clotting disorders. I realized I really wanted to learn more and do more, so I applied to medical school. When I was at MGH, I was the medical director of what we called the Medical Consultation Service. That role was great because I was consulted on many issues, especially those involving patients on the surgical floor. I had a lot of exposure to patients with blood clots during those 7-8 years.
I was also doing a lot of research at the time and decided to get a master’s in public health with an emphasis in quantitative methods, which gave me the skills and expertise to conduct studies. I became very interested in warfarin management, especially looking at how it can prevent strokes in patients with Afib. Now I devote a lot of my time to looking at the risks and benefits of anticoagulation.
Q: We’re just starting a new decade. What do you think is one of the most important findings from the last decade relating to blood clots?
The realization that there’s a high risk of stroke associated with Afib tops the list in my opinion. Now that the medical community knows that, patients need to know it, too. About 30% of patients with Afib either aren’t taking medications to prevent stroke, or they aren’t taking them properly, and that needs to change.
The evolution of anticoagulation has also been huge for patients. While there are still many reasons to use warfarin,the DOACs have been a gamechanger because now patients don’t need to be so concerned about lab monitoring, food interactions, etc.
Q: What do you tell patients who are hesitant to take anticoagulation?
Well, its super easy for me to have that conversation because my mother has Afib, so I’m living and breathing these decisions every day. I find that patients (and many providers) fear the risk of bleeding that comes with anticoagulation. I think it’s very important to realize that even if you have stomach bleeding, or even if you see blood in the toilet bowl, of course it’s frightening – but we can fix it most of the time. Strokes associated with Afib are known to be devastating, though. As a doctor, it’s very hard to see a patient who isn’t taking their medication be admitted for a stroke and be unable to speak or move their arms or legs.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) can also be deadly, so I work hard to help my patients understand the importance of taking anticoagulation. I always try to help them weigh the risks and benefits of the medication.
Q: February is American Heart Month. What’s some key heart-healthy advice you pass along to your patients?
I encourage people to have some moderate level of daily physical activity, and to be clear, that doesn’t mean buying a gym for your home or purchasing an expensive membership. It means getting out and walking. Get out there and walk 4 or 5 days a week for 30 minutes, put a couple hills in your walk, and it will make a difference. I also think it’s important tounderstand what a healthy diet really is. I like my patients to know that they can have control over their health andbodies. If you want to be a 90-year-old who’s still able to get up every day and walk around, a lot of that is up to you! I think patients need to put some skin in the game.
At the same time, I tell patients to listen to their bodies and to take unusual symptoms seriously. A relative of mine actually had a PE but didn’t appreciate that it was a PE at first. She thought she had a viral illness and had a little wheezing, but it just wasn’t going away. Her husband was the one who insisted that she get it checked out and sure enough, the doctor confirmed a PE. So, these are the things that are sometimes overlooked when we aren’t in tune with our bodies. Younger people especially overlook some of this stuff because they’re “not supposed” to get sick.
Q: You’re devoted to teaching and educating patients, but what’s the most important thing that a patient has taught you?
My patients have taught me to listen. One of the most rewarding things as an internal medicine physician is to get to knowpatients on a real human level. In today’s hurried environment, it’s important for me to spend time with my patients, even if I’m running late. I want to help them come to the best care decisions. I want to understand their barriers and challenges. It’s a privilege to be able to sit down, close the door, and have a conversation with a patient.
* Originally published in The Beat – February 2020. Read the full newsletter here.