Thrombosis is the process of formation of blood clots in the blood vessels such as veins and arteries.
The blood clot is also called a thrombus.
The treatment of thrombosis is done mainly through anticoagulant medicines, i.e. blood thinners such as heparin and warfarin.
Mechanical devices like compression stockings may also be used for the treatment.
The blood thinning drugs can cause severe bleeding side-effects like, heavy menstrual bleeding, nosebleeds, blood in urine or stool or coughing out blood.
There may be other side-effects such as dizziness, hair loss, rashes, and weakness in muscles.
The adverse effects of these drugs spark the need for a natural alternative that is effective in preventing thrombosis. Such a natural alternative is cocoa, the delectable food product.
What is Cocoa?
Cocoa is the powdered form of the fermented and roasted cocoa seeds. The cocoa tree, Theobroma cacao, belongs to the family Malvaceae.
The cocoa powder is mostly used in the confectionery. It is also used in bakery and cosmetics.
Cocoa has also been used in traditional medicine for the treatment of a cough, fever, diarrhea, rheumatism, malaria, etc.
Cocoa has a very diverse nutrient content. It is rich in carbohydrates, proteins, flavonoids (epicatechin & procyanidins), fatty acids, minerals (K, Mg, Ca, etc.), vitamins (A, B &C), methylxanthines (caffeine & theobromine) and other nutrients. 
The nutrient content of cocoa, especially the flavonoids endows it with the properties of therapeutic importance.
Some of these properties include antioxidant, anti-inflammatory, antiseptic, antidepressant, and anti-diabetic.
The wide range of properties of cocoa has medicinal value in several diseases such as infections, cardiovascular disorders, diabetes, obesity, neurodegenerative disorders, cancer, and many others.  
Cocoa For Thrombosis
Thrombosis can be life-threatening in many instances and increase the risk of diseases of heart, lungs, kidneys, etc.
Cocoa has the potential to overcome this problem by virtue of its activities against platelets and the process of the blood clotting.
1. Cocoa Inhibits Platelet Activity
The activation of platelets is central to the process of thrombosis or blood clot formation.
The aggregation of platelets and the assistance of various pro-coagulation factors such as thrombin, leukocytes, proinflammatory molecules lead to thrombosis and raise the risk of many diseases, especially, cardiovascular problems. 
Many natural compounds including the cocoa products are known to have antiplatelet activity, i.e. the ability to inhibit platelet function to prevent thrombosis and reduce the risk of associated diseases. 
Cocoa flavanols such as procyanidins are known to suppress the platelet activation in response to epinephrine (promotes blood clotting). 
In a study, cocoa flavanols’ dietary supplementation could inhibit platelet functions such as platelet aggregation.
The anti-inflammatory activity of the flavanols helps in increasing the antioxidant status of the blood and thus, prevents blood clotting. 
The flavanols’ anti-platelet activity depends on the reduction of oxidative stress which results in a decrease in pro-aggregation molecules (e.g. isoprostanes).
They also increase the nitric oxide (NO) levels in the blood which acts as a platelet inhibitor.
What does it Means? It means consumption of cocoa can inhibit the platelet activity in the blood vessels and thus, prevent thrombosis. The cocoa flavanols improve the antioxidant status of blood and thus, decrease the activity of pro-aggregation molecules to promote antithrombotic effects.
2. Casual Cocoa Consumption can help in Blood Thinning
It is often believed that a natural compound cannot be as beneficial in casual dietary consumption as medicine or its long-term intake in the extracted form will be.
However, it is not true, particularly for cocoa or dark chocolate consumption.
Cocoa or dark chocolate’s casual consumption has found to have benefits in a short-term.
In a study, it was found in the blood test after 4 hours of the cocoa intake that the time for blood to form clot significantly increased compared to the blood before cocoa ingestion.
Thus, it indicates that cocoa has blood-thinning effect. 
In another study, the casual consumption of commercial dark chocolate in moderate amount was seen to have notable anti-platelet activity. 
What does it Means? It means a regular consumption of commercial dark chocolate even in a moderate amount can have blood thinning effect. Thus, it can prevent thrombosis in the long run.
3. Cocoa’s Blood Thinning action is as Effective as Aspirin
Aspirin is a commonly used drug for the treatment of thrombosis. It is an anti-platelet drug, i.e. it inhibits the platelet aggregation to prevent thrombosis. 
Cocoa’s anti-platelet activity is comparable to aspirin. It prevents platelet aggregation just like aspirin.
The modulation of platelet function by cocoa is also found to be additive when cocoa is given together with aspirin. 
In a study, the combination of aspirin with cocoa enhanced the anti-platelet activity significantly. 
What does it Means? It means cocoa ingestion can effectively help in blood thinning and may be taken with or in place of aspirin. The blood thinning action of cocoa is as efficient as aspirin.
4. Cocoa’s Anti-Platelet activity Reduces Heart Risk induced by various Lifestyle Factors
The role of certain lifestyle risk factors is important in the progression of thrombosis in the arteries which increases the chances of heart diseases like hypertension, coronary artery disease, etc.
The common such lifestyle risk factors are stress, obesity, and smoking. 
Stress has become an inseparable part of everyday life of almost every person.
It is known that intense stress situation such as anger outburst or depression triggers prothrombotic response resulting in blood clot formation and an increased risk of heart diseases. 
Cocoa has been found to be useful in combating this situation.
In a study, cocoa consumption could inhibit the markers of prothrombotic response triggered by acute emotional stress.
It also helped in reducing the risk of coronary artery disease in the subjects. 
Obesity is another predominant lifestyle risk factor that can cause thrombosis.
It is known to promote blood clotting due to increased coagulation of platelets triggered by inflammation, oxidative stress, endothelial dysfunction, and atherosclerosis. 
Cocoa can be of great use here as well. It has been found to reduce the prothrombic state induced by obesity.
The cocoa flavanols improved endothelial dysfunction and decreased platelet activity through anti-inflammatory action.
It leads to anti-hypertensive effects and significantly lowered blood pressure. 
The habit of smoking is one of the deadliest hazards for human health.
One of its adverse effects is thrombosis.
It is found to increase the risk of blood clotting and thus leads to an increased chance of heart diseases like myocardial infarction, i.e. a heart attack. 
The nicotine ingestion through smoking leads to oxidative stress and thus, promotes thrombosis and enhances the risk of many diseases. 
Cocoa consumption has been found to have beneficial implications in the smoking-induced thrombosis and associated heart risk.
In a study, cocoa intake by smokers inhibited the platelet function by lowering the oxidative stress.
The cocoa polyphenols decreased the activity of the NOX2 enzyme (promotes thrombosis) which in turn lead to the deactivation of platelet aggregation factors like isoprostanes. 
The inhibition of the NOX2 enzyme by cocoa also leads to the reduction of arterial dysfunction caused by nicotine-induced thrombosis in smokers. 
What does it Means? It means cocoa consumption can help in the reduction of chances of heart diseases due to the induction of thrombosis by various lifestyle risk factors. The anti-platelet activity of cocoa flavanols ameliorates the prothrombotic conditions induced by these lifestyle risk factors.
5. Cocoa has Cardioprotective Effects
One of the major implications of thrombosis is the risk of cardiovascular diseases.
The function of the heart is almost entirely dependent on the blood flow and the function of veins and arteries.
Therefore, there is close inter-relation between the process of thrombosis and other cardiovascular damaging processes such as atherosclerosis and endothelial dysfunction.
Cocoa is known to have cardioprotective effects which involve the attenuation of the factors like thrombosis, endothelial dysfunction, and atherosclerosis. 
Effect of cocoa on Endothelial Dysfunction
Arterial thrombosis leads to the endothelial dysfunction by impairing the nitric oxide (NO) balance in the vascular system.
It causes disorders such as reduced vasodilation resulting in hypertension and other such disorders. 
Cocoa or dark chocolate consumption is known to improve the endothelial function and thus prevent cardiovascular disorders like hypertension. 
Studies have shown that cocoa flavanols increase the bioavailability of nitric oxide (NO) and thus, improve the endothelial function.
It reduces the risk of associated cardiovascular disorders.  
Effect of cocoa on Atherosclerosis
The formation of blood clots is often followed by the progression of atherosclerosis.
The atherosclerotic plaque attracts the platelets and coagulating factors and thus forms clots which become detrimental for cardiovascular health. 
The cocoa flavanols are known to prevent atherosclerosis through their antioxidant, anti-inflammatory, and antithrombotic actions and exhibit significant cardioprotective effects.
The reduction of atherosclerotic conditions has been found to be associated with the antioxidant and antithrombotic activity of dark chocolate.
It could improve coronary vascular function. 
The antioxidative activity of dark chocolate also improves the lipid profile, decreasing the bad cholesterols (LDL) and increasing the good cholesterols (HDL).
It has a major effect in the reduction of atherosclerosis and protection of the cardiovascular function.  
What does it mean? It means cocoa consumption can protect the cardiovascular system from the ill-effects of thrombosis and the inter-related endothelial dysfunction and atherosclerosis. Cocoa improves the endothelial function and reduces atherosclerosis through its antithrombotic, antioxidant and anti-inflammatory actions. Dark or white chocolate: Which is better for thrombosis?
Since there is a variety of chocolate available commercially, it becomes important to know which one will have better health benefits.
The commonly available chocolates are dark or white variety.
The dark chocolate consists of the fermented and roasted cocoa solids from the cocoa seeds whereas the white chocolate primarily consists of the cocoa butter.
Therefore, the major difference between the two is of flavanol content.
Dark chocolate has much higher flavanol content that the white variety. 
The antithrombotic and cardioprotective effect of chocolate is primarily due to the biological activities of its flavonol fraction.
Therefore, dark chocolate is more effective than white chocolate. 
Moreover, dark chocolate has been found to have better antiplatelet activity than white chocolate. 
White chocolate can improve the platelet function, but its effect is not profound.  
If we consider the evidence from various research studies, it is clear that dark chocolate is better to consume for thrombosis.
The particulars for the dosage of cocoa are not known for the condition of thrombosis.
However, a daily dose of 40-50 g of cocoa has shown significant antithrombotic activity is several studies.9 17 23 32 It means about 50 g of cocoa or dark chocolate can be consumed on a daily basis to tackle thrombosis and associated risk of diseases.
Dark chocolate (consisting more than 60% cocoa solids) or acute cocoa solids are best to consume in this condition due to the high flavanol content.
The dark chocolate bar can be ingested as it is. Cocoa powder can be added to milk, beverages or bakery items (with less sugar and refined flour).
In the dietary amounts, cocoa or dark chocolate intake is considered to be harmless.
A flavonol content of up to 2000mg per day (100g dark chocolate has about 650mg flavonols34) is found to be safe and efficacious in healthy adults. 
However, some precautions are mandatory as cocoa contains some potentially harmful compounds like caffeine.
1. Cocoa can cause allergy
2. Cocoa may Cause Anxiety
3. Cocoa can have Drug Interactions
4. Cocoa can trigger a Migraine Headache
5. Cocoa Increases the risk of Kidney Stone Formation
6. Cocoa should be avoided in Bleeding Disorders
7. Cocoa should be Avoided before Surgery
8. Cocoa can aggravate GERD or IBD symptoms
9. The high amount of cocoa is not safe for pregnant and breastfeeding women
Cocoa has a significant inhibitory effect on the platelet activity which helps in blood thinning.
Even the casual consumption of dark chocolate or cocoa has been seen to have notable benefits.
The antithrombotic property of cocoa reduces the chance of cardiovascular diseases from various lifestyle risk factors.
Its action against atherosclerosis and endothelial dysfunction further exert cardioprotective benefits.
Moreover, the anti-platelet activity of cocoa is as efficient as a commonly used anticoagulant drug, aspirin.
In conclusion, regular consumption of cocoa or dark chocolate can be perceived to be of immense potential in the prevention of thrombosis and associated diseases.