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A patient with calf pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Thrombophilia is a propensity to form thromboses. There are many known, and presumably unknown, causes of hypercoagulability. Some of the more common genetic and acquired causes were listed in the opening section of this question. The need for thrombophilia testing should be discussed with haematologists, and should be considered when there is spontaneous thrombosis in a younger person (<45 years), recurrent thrombosis, familial tendency to thromboembolism, or recurrent miscarriage.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
How do you treat thrombophilia?If thrombophilia is acquired, treat cause if possibleConsider primary anticoagulation or prophylaxis in patients at riskPrimary prophylaxis − prolonged hospitalisation postoperatively, immobilisation and in patients with active cancer.Long-term prophylaxis − complex assessment of all risk factors; liaise with haematology colleagues Benefits of anticoagulation must outweigh the risk of bleeding, especially in elderly patients.
Practice exam 2: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Maternal bloods – FBC, blood group and antibody, infection screen TORCH, Kleihauer, U + Es, LFTs, HbAlc, APS, activated protein C resistance.Post-mortem, umbilical cord blood, placenta for histology.Thrombophilia screening.
Reducing inappropriate inpatient thrombophilia testing through an electronic health record intervention
Published in Baylor University Medical Center Proceedings, 2023
Charis Durham, John Kim, Roma Bhandarkar, Daphne Garcia Galan, Alwin Alias, James Hall, Gerald Ogola, Micah Burch
Acquired and inherited forms of thrombophilia represent a variety of conditions that confer an increased risk of thrombosis.1 Unprovoked venous thromboembolic events, thrombotic events in young patients, or unusual sites of thrombosis (i.e., splanchnic, mesenteric, portal vein, cerebral venous sinus, etc.) are common scenarios where a hypercoagulable state may be suspected. Antiphospholipid antibody syndrome (APS) is an acquired autoimmune condition that is thought to lead to abnormal activation of the coagulation cascade.2 Although a variety of serum tests are available to evaluate these conditions, studies suggest that test results poorly predict thromboembolism recurrence.3,4 Literature demonstrates that inpatient workup of hereditary thrombophilia rarely changes patient management.5,6 For these reasons, guidelines on thrombophilia testing discourage hereditary thrombophilia workup for provoked thrombotic events in the inpatient setting.7–9 In instances of recurrent or unprovoked thrombosis, however, there may be some utility to inpatient thrombophilia testing. Hypercoagulability testing panels are costly, with prices ranging from $1100 to $2400.10,11
Clomiphene- induced pulmonary embolism
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
In our case, the patient had been started on clomiphene to treat hypogonadism, and after 6 months of therapy, he developed a deep vein thrombosis and pulmonary embolism. Our patient did not have any risk factors for PE, no suspicion of malignancy, and thrombophilia workup was negative. Even in patients with thrombophilia, clot formation is usually triggered by a pro-thrombotic drug (like Oral contraceptives)infections, immobilization, or malignancy. It is important to rule out thrombophilia as these patients are at an increased risk of clot formation and may need a longer duration of anti-coagulation. As our patient’s PE was caused by clomiphene, he was prescribed a 3-month course of anti-coagulation. Even though there are only a limited case reports of thrombosis associated with clomiphene, physicians should be cautious with its use and be mindful of the possibility of pulmonary embolism with clomiphene therapy.
Thrombophilia, risk factors and prevention
Published in Expert Review of Hematology, 2019
Elena Campello, Luca Spiezia, Angelo Adamo, Paolo Simioni
Inherited thrombophilia is a genetic propensity to develop venous thromboembolism (VTE). The most frequent causes are the factor V Leiden and the prothrombin gene mutation G20210A, accounting for about 50% to 70% of the diagnosed genetic thrombophilia. The less frequent but more severe defects of antithrombin (AT), protein C (PC) and protein S (PS) account for most of the remaining cases of diagnosed genetic thrombophilia [5–8]. More recently, new genetic defects responsible for severe thrombophilia have been identified, and namely, pseudo-homozygosity for activated protein C (APC) resistance, the hyperfunctional factor IX Padua, and the resistance to AT [9–11]. And last but not least, ABO blood group is the most common genetic risk factor for VTE [12]. Figure 1 summarizes known and currently diagnosed hereditary thrombophilias. There is a large number of families (about 30–40%) with symptomatic thrombophilia in which none of the known inherited conditions is identified. This unexplained thrombophilia is very likely to be due to genetic mutations that are still unknown.