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Chapter Ten Venous Disease Coalition

This toolkit provides a comprehensive overview of hypercoagulability and its impact on venous thromboembolism (VTE). It examines key factors such as Factor V Leiden, prothrombin variant 20210A, and antiphospholipid syndrome, along with deficiencies in proteins like Antithrombin, Protein C, and Fibrinogen. It outlines which patients are at increased risk for unprovoked VTE, offers guidance on when to consider hypercoagulability testing, and emphasizes evidence-based management strategies. This resource is essential for healthcare professionals addressing VTE in diverse patient populations.

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Chapter Ten Venous Disease Coalition

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  1. Chapter Ten Venous Disease Coalition Hypercoagulability VTE Toolkit

  2. Factor V Leiden • Prothrombin 20210A variant • AntiphospholipidAb syndrome • - lupus anticoagulant • - anticardiolipin antibody 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 DIC = disseminated intravscular coagulation; ET = essential thrombocytosis; PRV = polycythemiarubravera VTE Toolkit

  3. Unprovoked VTE at a young age • Recurrent, unprovoked VTE events • VTE with positive family history • VTE at an unusual site Which patients have an increased risk of having a hypercoagulable state? VTE Toolkit

  4. 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 Which patients have an increased risk of having a hypercoagulable state? VTE Toolkit

  5. ONLY if patient management will be • affectedby the result: • Management • affected? • Duration of anticoagulation(rarely) • Another medical intervention • pregnancy prophylaxis(sometimes) • BCP, HRT avoidance(possibly) • Family counseling(virtually never) General Indications forHypercoagulability Testing VTE Toolkit

  6. 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 • Almost never test relatives • - net harm generally greater than net benefit Principles ofHypercoagulability Testing VTE Toolkit

  7. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit

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