• Clinical science

Hypercoagulable states (Thrombophilia…)

Etiology

The etiology of thrombophilia can be classified into two categories:

Hereditary

Acquired

References:[1]

Clinical features

Thrombophilia is characterized by recurrent thromboembolism.

References:[2][3]

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%

Hyperhomocysteinemia

∼ 5–7%

References:[4][5][6][7][8]

Acquired thrombophilia

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

Malignancy

Immobilization

  • Prolonged immobilization (e.g., extended travel, hospitalization, bed rest) → increased venous stasis
Smoking
  • Causes endothelial damage
  • The risk is significantly higher in women who also use oral contraceptives.
Obesity

Antiphospholipid syndrome

Nephrotic syndrome

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

Heparin-induced thrombophilia
Pregnancy
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

References:[3][9][10][11]

Diagnostics

References:[2]

Treatment

Approach

Special considerations

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

References:[1][12][13]

Prevention

Consider prophylaxis in the following high-risk groups:

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