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Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

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Page 1: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Chapter TenVenous Disease Coalition

Hypercoagulability

VTE Toolk i t

Page 2: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Thrombophilia = Hypercoagulability

• Deficiencies of: Antithrombin Protein C Protein S Heparin cofactor II Factor VIII, IX, XI, II

• Hyperhomocysteinemia• Fibrinolytic dysfunction• Myeloprolif. disorders: - PRV, ET• Dysfibrinogenemia• DIC

• Factor V Leiden • Prothrombin 20210A variant• Antiphospholipid Ab syndrome - lupus anticoagulant - anticardiolipin antibody

VTE Toolk i t

DIC = disseminated intravscular coagulation; ET = essential thrombocytosis; PRV = polycythemia rubra vera

Page 3: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Which patients have an increased risk of having a hypercoagulable

state?

VTE Toolk i t

• Unprovoked VTE at a young age• Recurrent, unprovoked VTE events• VTE with positive family history• VTE at an unusual site

Page 4: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Which patients have an increased risk of having a hypercoagulable

state?

VTE Toolk i t

• Unprovoked VTE at a young age• Recurrent, unprovoked VTE events• VTE with positive family history• VTE at an unusual site

AND ALSO • Any unprovoked VTE event• VTE with minor risk factor such as BCP, HRT,

pregnancy, travel, bedrest only• Unexplained, recurrent pregnancy losses

Page 5: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

General Indications forHypercoagulability Testing

VTE Toolk i t

ONLY if patient management will be affected by the result:

Managementaffected?

1. Duration of anticoagulation(rarely)

2. Another medical intervention − pregnancy prophylaxis

(sometimes)− BCP, HRT avoidance

(possibly)3. Family counseling

(virtually never)

Page 6: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Principles ofHypercoagulability Testing

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1. Should only by done by experts- both in hypercoagulability + in the provision

of evidence-based patient counseling

2. Only if management is (should be) affected by the result = rare

3. Almost never test relatives - net harm generally greater than net benefit

Page 7: Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

Venous Disease Coalition

www.vasculardisease.org/venousdiseasecoalition/

VTE Toolk i t