Hypercoagulable States Thrombophilia its causes and diagnosis

Hypercoagulable States  Thrombophilia

Thrombophilia- a tendency to thrombosis

n       Also referred to as hypercoagulabe states, or prothrombotic disorders

n       Disorders that predispose a patient to venous, and sometimes to arterial, thromboembolism.

Whom to consider for investigation for thrombophilia

n       Thrombosis occurring at a young age (<45 yrs)

n       Idiopathic (venous thrombo-embolism) VTE

n       Recurrent VTE

n       Thrombosis at an unusual site

n       Family history of VTE or of inherited prothrombotic disorder

n       Recurrent/extension of thrombosis while adequately anticoagulated

Acquired Causes

n       In association with physiologic or thrombogenic stimuli:

n       Pregnancy (especially the post-partum period)

n       Immobilization

n       Trauma

n       Postoperative states

n       Advancing age

n       Estrogen use

n       Antiphospholipid syndrome

nn association with other clinical disorders:

n       Malignancy

n       Nephrotic syndrome

n       Heparin-induced thrombocytopenia

n       Myeloproliferative disorders

n       Paroxysmal nocturnal hemoglobinuria

n       Congestive heart failure

n       Atrial fibrillation

n       Inherited Causes
Deficiencies of antithrombin

n       Deficiencies of protein C

n       Deficiencies of protein S

n       Abnormal Prothrombin

n       Factor V Leiden

Recommended Laboratory Evaluation for Patients Suspected of
Having an Underlying Hypercoagulable State

Screening Tests

•      Activated protein C resistance •      Prothrombin G •      Antithrombin, protein C, and proteinS •      Factor VIII activity level •      Screening tests for lupus anticoagulants •      Confirmatory Tests •      Factor V Leiden PCR •      Antigenic assays for antithrombin, protein C, and/or protein S •      Confirmatory tests for lupus anticoagulants*