Hyper coagulation state

Najmeh VaghefMsc student in Tarbiat modares university

Introduction Definition of thrombus Review of coagulation triangular and it’s

relation with hyper coagulation Categories of thrombosis (arterial and

venous) and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation state

Introduction Definition of thrombus Review of coagulation triangular and it’s

relation with hyper coagulation Categories of thrombosis(arterial and venous)

and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation to state

Thrombus:A mass consist of blood elements that exist in circulation.

Introduction Definition of thrombosis Review of coagulation triangular and it’s

relation with hyper coagulation Categories of thrombosis (arterial and

venous) and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation to state

Procoagulant role of Elndothelial cells

Anticoagulant role of Endothelial cells

No Ecto ADPase PGI2 Heparan sulfate Thrombomadulin tpA

Platelet

Number Function

Platelet Activation Pathways

ADP

Adrenaline

PlateletGpIb

Exposed Collagen

Endothelium

vWFAdhesionAdhesion

THROMBIN

GpIIb/IIIaGpIIb/IIIa Aggregation

Coagulation Factors and inhibitors

Introduction Definition of thrombosis Review of coagulation triangular and it’s

relation with hyper coagulation Categories of thrombosis (arterial and

venous) and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation to state

Thrombosis:

ArterialIschemia and Infarctus

VenousEdema and emboli

(white thrombus)

(red thrombus)

Inheritedhypercoagulable

states

Inheritedhypercoagulable

statesAcquired

hypercoagulablestates

Acquiredhypercoagulable

states

ThrombosisThrombosis

Etiology of arterial thrombosis

Atherosclerosis Hypertension Hyper vescositemia Diabetic mellitus Hyper lypemia Vacuities Anti phospholipids syndrome

Some hematological syndromes: TTP ,HUS, HITTS, Myeloprotive disorders,

Increase some proteins and amino acids: Lpa )LDL+Apoa(, Homocystein ) aquired and hereditary( ,Factor VII

Etiology of arterial thrombosis

Homocysteinemia and hyper coagulation state Increase connection of Lpa to fibrin

Bad functional of Endothelial Cells )Anticoagulant surface change to procoagulant surface (

Reduced thrombomadulin Reduced tpA Reduced APC Increase factor )V(

Treatment of arterial thrombosis

Anti platelet Anticoagulant If homocysteinemia exists with

thrombosis +foliate

Etiology of venous thrombosis

Stasis Hyper coagulability Endothelial injury

Virchow’s Triad

Hypercoagulability Endothelial injury Venous flow

disturbance )stasis or turbulence(

Hyper coagulability

Protein defects:

Factor )V( Leiden ) 20-40%( G to A mutation at base pair 1691

results in amino acid 506,Glu instead of Arg

Prothrombin 20210 )6%()G to A(Defect or deficiency of protein C )4%( )outozomal dominant(

Defect or deficiency of Protein S )3-4%( ) outozomal dominant( pregnancy and estrogens reduced protein S

Dysfibrinogenemia ) 3% (Antithrombin deficiency ) 1% (

)outozomal dominant ( acquired deficiency of it happened in sever obesity , liver disease , chronic renal failer , using ocp ,immature neonates

Hyper coagulability

Dysplasminogenemia ) <1% (Reduced Heparin cofactor IIElevation of PAI-1Elevation of Coagulation factors

VII,VIII,IX,X,XI and IIReduction of protein Z Xa

Z XvitK

Hyper coagulability

Hematologic diseases :DICHITTSAnti phospholipid syndromeTTPHUSPlatelet disordersHomocysteinemia

Hyper coagulability

Risk factors for venous thrombosis

Age Prolonged immobility Obesity Neurological disease Cardiac disease Pregnancy Oral contraceptive (ocp) if the patient has

the factor ( V ) leiden mutation the risk is increased 28-fold

Surgery Malignancy

Treatment of venous thrombosis

Anti fibrin-generating agents )Heparin, Hirudin, argatroban, LMW Heparin, Warfarin (

Lyses of cloths with thrombolytic therapy ) tpA, Streptokinase, Urokinase(

Introduction Definition of thrombosis Review of coagulation triangular and it’s

relation with hyper coagulation categories of thrombosis (arterial and

venous) and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation to state

3 questions in thrombosis

Thrombosis is venous or arterial ?Cause of thrombosis : acquired or hereditary?Acquired:

Vascular disorders ) atherosclerosis , diabetic mellitus , vacuities , homocysteinemia (

Acquired

Blood flow disorders:

Stasis )immobility , CHF( Hypervescoshtemia ) P.V ,Leukemia ,

plasma cell disorders , sickle cell anemia

Platelet disordersMyeloprolifrativedisorders ,

thrombocytosis , hyper lypemia , PNH

Acquired

Coagulation and Fibrinolytic disorders

Malignancies , nephritic syndrome , trauma , hyperthyroidism , liver disease , operation

Hematological disorders TTP , HUS , HITTS , DIC

What cases need to follow up? Answer :

Familial thrombosisRecurrent autonomous thrombosis

Thrombosis in youth Surface migrant thrombofelebitsThrombosis in unusual sitesRecurrent abortions

Cases that need to follow up for hyper coagulation state

Introduction Definition of thrombosis Review of coagulation triangular and it’s

relation with hyper coagulation Divided thrombosis tow categories (arterial

and venous) and review of their etiology and their treatments

The importance of getting case report properly and familial history of thrombosis

Review of lab tests for diagnostic of hyper coagulation to state

Lab tests for diagnostic of hyper coagulation state

Factor ( V ) leiden Antithrombin III Prothrombin 20210 Protein C Protein S Protein Z Homocystein Specific platelet protein and increase of it’s

metabolism Decrease of fibrinolytic action ACLA, LACT, dRWVT D-dimmer , PTT

Thank you for your

attention

Thank you