chapter ten venous disease coalition
DESCRIPTION
Chapter Ten Venous Disease Coalition. Hypercoagulability. VTE T oolkit. Factor V Leiden Prothrombin 20210A variant Antiphospholipid Ab syndrome - lupus anticoagulant - anticardiolipin antibody. Thrombophilia = Hypercoagulability. Deficiencies of: Antithrombin - PowerPoint PPT PresentationTRANSCRIPT
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Chapter TenVenous Disease Coalition
Hypercoagulability
VTE Toolk i t
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Thrombophilia = Hypercoagulability
• Deficiencies of: Antithrombin Protein C Protein S Heparin cofactor II Factor VIII, IX, XI, II
• Hyperhomocysteinemia• Fibrinolytic dysfunction• Myeloprolif. disorders: - PRV, ET• Dysfibrinogenemia• DIC
• Factor V Leiden • Prothrombin 20210A variant• Antiphospholipid Ab syndrome - lupus anticoagulant - anticardiolipin antibody
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DIC = disseminated intravscular coagulation; ET = essential thrombocytosis; PRV = polycythemia rubra vera
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Which patients have an increased risk of having a hypercoagulable
state?
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• Unprovoked VTE at a young age• Recurrent, unprovoked VTE events• VTE with positive family history• VTE at an unusual site
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Which patients have an increased risk of having a hypercoagulable
state?
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• Unprovoked VTE at a young age• Recurrent, unprovoked VTE events• VTE with positive family history• VTE at an unusual site
AND ALSO • Any unprovoked VTE event• VTE with minor risk factor such as BCP, HRT,
pregnancy, travel, bedrest only• Unexplained, recurrent pregnancy losses
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General Indications forHypercoagulability Testing
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ONLY if patient management will be affected by the result:
Managementaffected?
1. Duration of anticoagulation(rarely)
2. Another medical intervention − pregnancy prophylaxis
(sometimes)− BCP, HRT avoidance
(possibly)3. Family counseling
(virtually never)
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Principles ofHypercoagulability Testing
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1. Should only by done by experts- both in hypercoagulability + in the provision
of evidence-based patient counseling2. Only if management is (should be)
affected by the result = rare
3. Almost never test relatives - net harm generally greater than net benefit
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Venous Disease Coalitionwww.vasculardisease.org/venousdiseasecoalition/
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