Makindo Medical Notes

Introduction

• There is a constant dynamic of anti thrombotic and pro thrombotic factors
• Hypercoagulable state is due to
  • Lack of intrinsic Antithrombotic factors
    • Antithrombin (III) deficiency
    • Protein C deficiency
    • Protein S deficiency
  • Excess intrinsic Prothrombotic factors
    • Factor Va (activated protein C resistance; factor V Leiden)
    • Prothrombin (prothrombin G20210A mutation)
    • Factor IX Padua (factor IX R338L mutation)
    • Factors VII, XI, IX, VIII; von Willebrand factor; fibrinogen (epidemiologic data; molecular mechanisms unknown

Summary

Manifestations

• Deep venous thrombosis (DVT) of the lower extremities
• Pulmonary embolism
• Venous thromboses causing superficial thrombophlebitis and splanchnic veins
• Cerebral venous thrombosis
• Recurrent pregnancy loss with APS
• Arterial thrombosis with APS

Arterial thrombosis involving the coronary, cerebrovascular, and peripheral circulations is not generally linked to any of the primary hypercoagulable states. However, venous thrombosis can result in arterial occlusion by paradoxical embolism across a patent foramen ovale.

Clots often provoked due to Primary Hypercoagulable state + Precipitant e.g.

• Pregnancy
• Use of oral contraceptives
• Post op Surgery
• Trauma
• Immobilization
• Active cancer
• chronic inflammatory disease (e.g., extensive psoriasis)
• Myeloproliferative neoplasm,
• Hormone replacement therapy

Who to Screen: Advice is Not every DVT/PE but those with

• Age < 40 years
• First degree relatives with unprovoked or recurrent DVT/PE
• Recurrent DVT/PE