eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

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

Author: Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
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
Contributor Information and Disclosures

Updated: Oct 22, 2009

Follow-up

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 when there is an 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.

Complications

See Mortality/Morbidity.

Prognosis

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

Miscellaneous

Medicolegal Pitfalls

  • The question of when to test a patient for thrombophilia could become a medicolegal pitfall. For example, should every woman be tested before being started hormone replacement therapy? This is currently not done, but it could be argued that physicians may be liable if a patient is not tested.
  • The question of when a patient with a thrombophilia should be on long-term anticoagulation is one of conflicting opinions. Legal issues may arise if a patient with a known thrombophilia develops a venous thrombosis if the patient had not been anticoagulated.
  • Legal issues may also be raised if a patient has significant bleeding due to anticoagulation that was initiated without a valid indication.
 


More on Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli

Overview: Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli
Differential Diagnoses & Workup: Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli
Treatment & Medication: Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli
Follow-up: Hypercoagulability - Hereditary Thrombophilia and Lupus Anticoagulants Associated With Venous Thrombosis and Emboli
References
Further Reading
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References

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Keywords

hypercoagulability, hereditary thrombophilia, thrombosis, DVT, pulmonary embolism, vein thrombosis, venous thrombosis, deep venous thrombosis, hypercoagulable state, emboli, embolism, hemostasis disorder, anticoagulant therapy, heparin, antithrombin agents, hereditary thrombophilia, lupus anticoagulants, blood coagulation disorder, acquired hypercoagulability, thromboembolic disease, blood clots

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Contributor Information and Disclosures

Author

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

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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 Osteopathic Internists, 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: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, 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 Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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