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Thrombophilia and Hypercoagulable States

Touqir Zahra, MD, FACP and Raksha Sharma, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • An inherited or acquired disorder of the coagulation system predisposing an individual to thromboembolism (the formation of a venous, or less commonly, an arterial blood clot)

  • Venous ...

DIAGNOSIS

HISTORY

Consider prothrombotic assessment for the following: 
  • Recurrent VTE events

  • Thrombosis at an age younger than 50 years, particularly in the absence of provoking factors such as recent su...

TREATMENT

  • Assess VTE risk:

    • Low-risk inherited thrombophilias: heterozygous FVL, heterozygous prothrombin 20210 mutation

    • High-risk inherited thrombophilias: protein C deficiency, protein S def...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Monitor warfarin with INR goal of 2 to 3. 

DIET

  • Vitamin K–stable diet if patient is taking warfarin

  • Rivaroxaban should be taken with a large meal ...

REFERENCES

1
Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, et al. American Society of Hematology 2023 Guidelines for Management of Venous Thromboembolism: Thrombophilia Testing. Blood Adv. 2023:blood...

CODES

ICD10

  • D68.59 Other primary thrombophilia

  • D68.51 Activated protein C resistance

  • D68.2 Hereditary deficiency of other clotting factors

  • D68.8 Other specified coagulation defects

  • D53.0 Protein deficiency...

CLINICAL PEARLS

  • Factor V Leiden (FVL) (resistance to aPC) most common inherited thrombophilia.

  • For patients <45 with VTE, suggest testing for inherited thrombotic disorders

  • Rule out malignancy, espec...

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