What commonly used medication is known to increase the risk of thrombotic events?
oral contraceptives
What is Virchow’s triad?
- stasis
- hypercoagulable state
- endothelial trauma
If someone comes in with an acute thrombosis what 4 hypercoagulable disorder tests cannot be done?
- Protein C
- Protein S
- Lupus anticoagulant
- Antithrombin (AT) deficiency
Which 2 of the thrombophilia disorders can be arterial?
- Antiphospholipid Syndrome (APS)
- hyperhomocysteinemia
What is the step wise process in evaluating a embolic event? (5 steps)
- EKG/telemetry
- vascular U/S
- hypercoagulable laboratory eval
- TEE
- Chest CT
How is APS diagnosed using the Sydney Criteria?
Need to have either:
- Vascular thrombosis
- Pregnancy morbidity
AND 1+ of the following need to be positive 2x >12 weeks apart:
- anticardiolipin antibodies (aCL)
- anti-beta2-glycoprotein-I antibodies (aB2GPI)
- lupus anticoagulant (LA) test
What are the 5 inherited thrombophilia disorders?
- factory V leiden mutation
- prothrombin G gene mutation
- Protein S deficiency
- Protein C deficiency
- Antithrombin deficiency
Testing for which of the thrombophilia disorders is not recommended?
hyperhomocysteinemia
When do you consider performing a JAK2 mutation test?
thrombosis in unusual vascular bed (portal, hepatic, mesenteric)
The first thing you look for when evaluating for Factor V leiden mutation is what?
activated protein C
*Factor V Leiden makes Factor V insensitive to protein C
All of the inherited thrombophilia disorders are associated with what type of thrombosis?
venous
Which study might be prolonged in lupus anticoagulant?
PTT
In which 8 situations would you evaluate for a hypercoagulable state?
- unprovoked VTE age <45
- unprovoked VTE with FMx
- recurrent events
- thrombosis in unusual vascular bed
- warfarin necrosis
- findings for malignancy
- risk for malignancy
- strong FMx VTE
In these 7 situations evaluating for a hypercoagulable state is not recommended
- first unprovoked VTE
- active malignancy
- IBS
- myeloproliferative disorder
- heparin induced thrombocytopenia with thrombosis
- retinal vein thrombosis in setting of preeclampsia
- unselected screening
for first time unprovoked VTE what is the duration of VKA therapy?
3 months
6 months for secondary prophylaxis of VTE
recurrent miscarriages warrants what test?
-antiphospholipid syndrome (APS) test
What 2 hypercoagulable disorders cannot be measured if a patient is on warfarin?
- Protein C deficiency
- Protein S deficiency
What 2 hypercoagulable disorders cannot be measured if a patient is on heparin?
- Antithrombin (AT) deficiency
- Lupus anticoagulant
In an acute thrombosis what 2 hypercoagulable disorders can be lowered?
- Protein S deficiency
- Antithrombin (AT) deficiency
