46 - Hypercoaguable Disorders

Question 1

What is the most frequent cause of inherited thrombophilia?

Answer 1

Factor V Leiden mutation

Question 2

What are some prophylactic measures that can be utilized to decrease the risk of thrombosis?

Answer 2

• Sequential compression devices
• Compression stockings - TED hose
• Ambulation
• LMWH
• NOT strict bed rest

Question 3

What tests should you run if you have a patient with a red, warm, swollen and tender leg or pulmonary embolism?

Answer 3

Diagnostic tests

Initial tests

• Duplex ultrasound
• D-dimer
• Chest CT

Blood tests (can do initially)

• Resistance to activated protein C clotting assay
• Genetic testing for prothrombin G20210A mutation
• Functional Assay of antithrombin
• Functional Assay of protein C
• Functional Assay of protein S
• Clotting assay for lupus anticoagulant
• ELISA for anticardiolipin antibodies
• Fasting total plasma homocysteine

Question 4

How do you treat a thrombosis?

Answer 4

Treatment

• Acute: heparin
• Long-term: warfarin

We put patients on heparin first because warfarin is not effective right away, and also because you are going to decrease the protein C and S concentration when they are given warfarin initially so you will actually have some pro-coaguable tendencies