Hereditary and Acquired Hypercoagulability  Questions & Answers

Updated: Jan 05, 2018
  • Author: Paul Schick, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Questions & Answers

Overview

Which conditions are patients with hereditary and acquired hypercoagulability at higher risk of developing?

What are the most common risk factors for acquired hypercoagulability and thrombosis?

How do obesity and diabetes affect the incidence of acquired hypercoagulability?

What are idiopathic venous thrombotic events?

What are the hereditary thrombophilias?

What is the role of the Virchow triad in the pathogenesis of hereditary and acquired hypercoagulability?

What is the pathogenesis of hypercoagulability?

What is the role of hemodynamic dysfunction in the pathogenesis of hereditary and acquired hypercoagulability?

What is the role of endothelial injury in the pathogenesis of hereditary and acquired hypercoagulability?

Which factors increase the risk of acquired hypercoagulability during pregnancy?

What is the pathophysiology of hereditary and acquired hypercoagulability in lupus?

What is the pathophysiology of hereditary and acquired hypercoagulability in non-O blood type?

What is the role of genetics in the pathogenesis of hypercoagulability?

What is the role of activated protein C (APC) resistance in the pathogenesis of hypercoagulability?

What is the role of factor V Leiden resistance in the pathogenesis of hypercoagulability?

What causes factor V Leiden in the pathogenesis of hypercoagulability?

What is the incidence of factor V Leiden in hereditary and acquired hypercoagulability?

What is the role of prothrombin G20210A in the pathophysiology of hereditary and acquired hypercoagulability?

When should patients be screened for factor V Leiden and prothrombin G20210A to prevent hypercoagulability?

What is the prevalence of hereditary and acquired hypercoagulability in the US?

What is the incidence of venous thromboembolism in first-degree relatives of patients with hereditary and acquired hypercoagulability?

What is the mortality rate for hereditary and acquired hypercoagulability?

What significantly increases the risk for hereditary and acquired hypercoagulability?

Which age group is at highest risk for hypercoagulability?

Presentation

What are the clinical symptoms of underlying hereditary and acquired hypercoagulability?

What history findings suggest a hereditary thrombophilic disorder?

Which disorders are suggested in the presence of purpura fulminans in infancy?

Which conditions may cause arterial thrombosis?

Which disorders are associated with antiphospholipid antibodies (lupus anticoagulants)?

What are the Sapporo diagnostic criteria for antiphospholipid syndrome?

What are the most common acquired causes for hypercoagulability?

DDX

Which conditions should be included in the differential diagnosis of hereditary and acquired hypercoagulability?

Workup

When is a workup for hereditary and acquired hypercoagulability indicated?

Is thrombophilia workup indicated in patients with idiopathic venous thrombosis?

What are the challenges in the decision to order a workup for hereditary and acquired hypercoagulability?

What are the indications for a workup for hereditary and acquired hypercoagulability in children?

What are the benefits of testing for thrombophilia and antiphospholipid syndrome (lupus anticoagulants) in hereditary and acquired hypercoagulability?

What are the testing recommendations for patients who have an identifiable thrombophilic risk factor?

Which tests are available to detect hereditary and acquired hypercoagulability?

Which screening tests are used for antiphospholipid syndrome (lupus anticoagulant) in hereditary and acquired hypercoagulability?

How is the diagnosis of antiphospholipid syndrome (lupus anticoagulant) confirmed in hereditary and acquired hypercoagulability?

Which lab tests are performed in patients with suspected factor V Leiden?

Which lab results suggest factor V Leiden APC resistance in hereditary and acquired hypercoagulability?

What is the role of antithrombin deficiency studies in the evaluation of hereditary and acquired hypercoagulability?

Which studies are performed in the diagnosis of a protein C deficiency in hereditary and acquired hypercoagulability?

Which studies are performed in a diagnosis of a protein S deficiency in hereditary and acquired hypercoagulability?

What are the limitations of lab studies used to rule out an underlying thrombophilia in hereditary and acquired hypercoagulability?

Treatment

What are the indications for primary prophylaxis in hereditary and acquired hypercoagulability?

What is included in the medical care for hypercoagulability during pregnancy?

What are the treatment options for a venous thrombotic event or pulmonary embolus in hereditary and acquired hypercoagulability?

What is the basis for the decision to institute long-term or extended anticoagulation in hereditary and acquired hypercoagulability?

What is the basis for the decision to institute long-term or extended anticoagulation in patients with lupus anticoagulants in hereditary and acquired hypercoagulability?

How is the risk of thrombosis versus the risk of bleeding weighed in the treatment of hereditary and acquired hypercoagulability?

How is thrombosis risk assessed in pediatric patients with hereditary and acquired hypercoagulability?

What is the role of direct factor Xa inhibitors and direct thrombin inhibitors in the treatment of hereditary and acquired hypercoagulability?

What are the advantages of direct factor Xa inhibitors and direct thrombin inhibitors in the treatment of hereditary and acquired hypercoagulability?

What is the role of oral and parenteral thrombin inhibitors and Xa inhibitors in the prevention of thrombosis?

Which specialist consultations are needed for the treatment of hereditary and acquired hypercoagulability?

How is unfractionated heparin therapy monitored during the treatment of hereditary and acquired hypercoagulability?

How is low molecular weight heparin (LMWH) monitored during the treatment of hereditary and acquired hypercoagulability?

What are the factors that complicate the monitoring of low molecular weight heparin (LMWH) in the treatment of hereditary and acquired hypercoagulability?

What are the American College of Chest Physicians (ACCP) and British Committee for Standards in Haematology guidelines for monitoring low molecular weight heparin (LMWH) in the treatment of hereditary and acquired hypercoagulability?

How are thrombin inhibitors monitored during the treatment of hereditary and acquired hypercoagulability?

How bleeding episodes managed in hereditary and acquired hypercoagulability?

What is the role of protamine in the treatment of hereditary and acquired hypercoagulability?

What methods are used to reverse anticoagulation due to factor Xa in the treatment of hereditary and acquired hypercoagulability?

What is the role of recombinant factor VIIa in the treatment of hereditary and acquired hypercoagulability?

What is the role of monitoring during anticoagulation therapy for hereditary and acquired hypercoagulability?

What is the role of idarucizumab in the treatment of hereditary and acquired hypercoagulability?

Follow-up

What are indications for prophylactic anticoagulation in hereditary and acquired hypercoagulability?

What is the prognosis of hereditary and acquired hypercoagulability?