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Thrombophilia and Hypercoagulable States

Kirsten Vitrikas, MD Reviewed 06/2018
 


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) (1)

  • Ven...

DIAGNOSIS

HISTORY

Consider prothrombotic assessment for the following: 
  • Thrombosis at an unusual anatomic site or recurrent thromboses

  • Family history suggesting multiple individuals affected with VTE

  • Recu...

TREATMENT

MEDICATION

First Line

  • Newer oral anticoagulants: apixaban, dabigatran, edoxaban, and rivaroxaban are now recommended over vitamin K antagonists for long-term oral anticoagulation (6)[B].

  • Parent...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Avoid significant risk for trauma (e.g., contact sports, climbing a ladder). 

Patient Monitoring

Monitor warfarin as frequently as needed to maintain an INR goal of...

REFERENCES

1
Cohn DM, Vansenne F, de Borgie CA, et al. Thrombophilia testing for prevention of recurrent venous thromboembolism. Cochrane Database Syst Rev.  2012;(12):CD007069. [View Abstract on...

ADDITIONAL READING

Stevens SM, Woller SC, Bauer KA, et al. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis.  2016;41:154–164. [View Abst...

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 (resistance to aPC) is the most common inherited thrombophilia, with a prevalence of 2–7% in the U.S. Caucasian population.

  • Test patients for thrombophilias only if it w...

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