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Hypercoagulable states

Last updated: November 3, 2020


The etiology of thrombophilia can be classified into two categories:


Clinical features

Thrombophilia is characterized by recurrent thromboembolism.


Hereditary thrombophilia

Defect Pathophysiology Prevalence in general population

Activated protein C resistance (APC-R)

Factor V Leiden

Heterozygosity: ∼ 5%
Homozygosity: < 1%
Elevated factor VIII ∼ 5%
Prothrombin mutation ∼ 3%
Protein S deficiency ∼ 1%
Protein C deficiency

< 1%

Antithrombin III deficiency ∼ 0.1%


∼ 5–7%


Acquired thrombophilia

Etiology Pathophysiology
  • Extended immobilization during procedure → blood stasis
  • Vessel instrumentation → endothelial damage
  • Results in decreased venous blood flow, immobilization (blood stasis), and release of tissue factor (hypercoagulability) → increased clotting



  • Prolonged immobilization (e.g., extended travel, hospitalization, bed rest) → increased venous stasis

Antiphospholipid syndrome

Nephrotic syndrome

Oral contraceptive pills (OCPs) or hormone replacement therapy (HRT)

Heparin-induced thrombophilia
Advanced age
  • Progressive endothelial damage
  • Increase in pro-clotting factors without a concomitant increase in protein C
  • Increase in other pro-clotting comorbidities (e.g., malignancy)
  • Decreased physical activity






Special considerations

The risk of venous thromboembolism is reduced with administration of an anticoagulant (e.g., heparin) following surgery!



Consider prophylaxis in the following high-risk groups:

  • Postoperative patients
  • Prolonged immobilization or hospitalization
  • Malignancy
  • Orthopedic conditions


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