Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli Follow-up

  • Author: Paul Schick, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Oct 3, 2011
 

Deterrence/Prevention

  • If a patient is known to have a lupus anticoagulant or a thrombophilia, it is important to avoid oral contraceptives and hormone replacement therapy. Also, prophylactic anticoagulation should be considered in patients with additional risk for venous thrombosis, such as immobilization and surgery.
  • The risk of venous thrombosis is considerably greater in patients with 2 hereditary thrombophilias or with a thrombophilia and an acquired hypercoagulable disorder. Prophylactic therapy should be considered in these circumstances.
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Complications

See Mortality/Morbidity.

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Prognosis

The prognosis is probably worse in patients with antithrombin III deficiency and lupus anticoagulants than in those without these factors.

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Contributor Information and Disclosures
Author

Paul Schick, MD  Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara P Schick, PhD  Professor, Department of Medicine, Cardeza Foundation; Professor, Department of Biochemistry and Molecular Pharmacology, Professor, Department of Biochemistry and Molecular Biology, Jefferson Medical College of Thomas Jefferson University

Disclosure: Nothing to disclose.

Specialty Editor Board

Pradyumna D Phatak, MBBS, MD  Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute

Pradyumna D Phatak, MBBS, MD, is a member of the following medical societies: American Society of Hematology

Disclosure: Novartis Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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Table 1. Thrombophilic or Hereditary Hypercoagulable Disorders in the General Population and in Persons With Venous Thrombosis[10]
ConditionPrevalence in General Population, %Relative Risk of VTE, %Relative Risk of Recurrent VTE, %
Factor V Leiden3-74.31.3
Prothrombin 20210A1-31.91.4
Protein C0.02-0.0511.32.5
Protein S0.01-132.42.5
Antithrombin III0.02-0.0417.52.5
VTE = Venous thromboembolism.
Table 2. Several Commonly Used Antithrombotic Agents
AnticoagulantRisksMonitoringAntidote for BleedingHalf-life
HeparinBleeding HITaPTTProtamine< 60 min
LMWHBleeding HITFactor XaProtamine (< 60%) and in some cases is ineffectiveVariable
WarfarinBleedingPTVitamin K & FFP*Several days
FondaparinuxBleedingFactor XaNone15 h
Lepirudin



Argatroban



BleedingNoneNone1-3 h



30-60 min



PT = Prothrombin time.



*Fresh frozen plasma (FFP) can be used to reverse acute bleeding in patients with high INRs due to warfarin overdose. Recombinant factor VIIa and prothrombin complex concentrates also have been used in these patients, but the risk of thrombosis due to these agents is being evaluated.[28, 29]



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