Hypercoagulable State - Detection & Screening

4/23/2003

Question: Which procedures are most useful for the detection of hypercoagulable states, and which patients should be routinely screened for this condition?

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Unique Identifier:11021259

Authors: Barger AP. Hurley R.

Institution: University of Minnesota Medical School-Minneapolis, USA. amy.p.barger@healthpartners.com

Title: Evaluation of the hypercoagulable state. Whom to screen, how to test and treat. [Review] [22 refs]

Source: Postgraduate Medicine. 108(4):59-66; quiz 17, 2000 Sep 15.

Abstract: Venous thromboembolism is a common disease that causes significant morbidity and mortality. In recent years, the ability to diagnose inherited genetic defects and common acquired conditions predisposing to thrombosis has greatly increased. Venous thromboembolism is now understood to be a complex interaction of genetic and environmental factors leading to thrombosis. Integrating the various factors to individually assess thrombotic risk still poses a challenging clinical problem that will likely become easier as more data accumulate. As the ability to accurately assess risk increases, the data can then be translated into tailored treatment regimens. Until then, only general guidelines regarding evaluation and management are available. In the future, it is likely that other prothrombotic conditions will be elucidated, adding to the pool of data. [References: 22] CAS Registry/EC Number 0 (Anticoagulants). 0 (Blood Coagulation Factor Inhibitors).

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Unique Identifier:9950260

Authors: Lopez Y. Paloma MJ. Rifon J. Cuesta B. Paramo JA.

Institution: Hematology Services, University Clinic, School of Medicine, University of Navarra, Pamplona, Spain.

Title: Measurement of prethrombotic markers in the assessment of acquired hypercoagulable states.

Source: Thrombosis Research. 93(2):71-8, 1999 Jan 15.

Abstract: Hypercoagulable states can be detected by measuring activation peptides, enzyme-inhibitor complexes, and fibrin/fibrinogen degradation products, which are markers of hemostatic activation. A series of these prethrombotic markers has been evaluated in the elderly, pregnancy, diabetes and acute myocardial infarction patients (n=30 in each group) as well as in hematologic malignancies (n=42). The parameters assayed were: prothrombin fragment 1+2 (F1+2), thrombin-antithrombin III complexes (TAT), fibrinopeptide A (FPA), plasmin-alpha2 antiplasmin complexes (PAP) and D-Dimer. Results were compared with those obtained in a group of 30 healthy subjects. We found a significant increase of F1+2, TAT and FPA in elderly (p<0.05), acute myocardial infarction (AMI) (p<0.01), hematologic malignancies (p<0.01), and pregnancy (p<0.0001), indicating a marked clotting activation. Diabetic patients under strict metabolic control only presented a moderate increase of TAT (p<0.05), suggesting a slight activation. We also observed a highly significant elevation of PAP and D-Dimer in elderly (p<0.001), AMI (p<0.0001), and malignancy (p<0.0001), indicating an activation of the fibrinolytic system. The combination of selected fibrinolytic and coagulation measurements is useful for the detection of a hypercoagulable state in conditions characterized by a risk of thrombosis. CAS Registry/EC Number 0 (Biological Markers).

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Unique Identifier:2359194

Authors: Donaldson MC. Weinberg DS. Belkin M. Whittemore AD. Mannick JA.

Institution: Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.

Title: Screening for hypercoagulable states in vascular surgical practice: a preliminary study.[comment].

Source: Journal of Vascular Surgery. 11(6):825-31, 1990 Jun.

Abstract: The prevalence and importance of hypercoagulable states in the general vascular surgical population is unknown. Antithrombin III, protein C, protein S, plasminogen, lupus-like anticoagulant, and heparin-induced platelet activation were determined prospectively in 158 patients with aneurysmal (27), renovascular (1), cerebrovascular (28), aortoiliac (31), or infrainguinal (71) disease. Sixteen abnormal test results were obtained in 15 patients (9.5%) as follows: deficiencies of antithrombin III (2), protein C (4), and protein S (1) and presence of lupus-like anticoagulant activity (5) and heparin-induced platelet activation (4). Reconstructive surgery was performed in 137 of the study patients. Five reconstructions, all infrainguinal bypass grafts, suffered thrombosis within 30 days. Early graft thrombosis occurred in three (27%) of 14 patients with abnormal preoperative test results compared to two (1.6%) of 123 patients with normal testing (p less than 0.01). Of the three patients with abnormal test results and graft thrombosis, lupus-like anticoagulant was detected in two and heparin-induced platelet activation in one. This preliminary study supports routine preoperative screening for lupus-like anticoagulant and heparin-induced platelet activation in patients undergoing infrainguinal reconstruction. Hypercoagulable states appear to be sufficiently common and important in the general vascular surgical population to warrant further investigation. CAS Registry/EC Number 0 (Blood Coagulation Factors).