Thrombosis, tendency for
Description |
See table 1 Please also refer to section “Heparin-induced thrombocytopenia type II” Indication of thrombophilia diagnostics in asymptomatic patients: In case of increased thromboembolic complications in first grade relatives and expected thrombosis-favoring situation:
The scale of thrombophilia diagnostics after initial thrombosis is mainly dependent of the preventive-therapeutic consequences, meaning, the question, whether a 3-6-monthly or longer-term (life-long) anticoagulation is required. An increased thrombosis tendency and the corresponding requirement of increased laboratory analytics can be estimated by the following criteria:
It is recommended to take bloods 3 months after the acute event. Vitamin-F-dependent proteins C and S can only be evaluated three weeks after discontinuing oral anticoagulants. Arguments for long-term (life-long) anticoagulation:
Thrombophilia diagnostics prior to taking hormones, this includes ovulation inhibitors: Prior to taking ovulation inhibitors the evaluation of factor V-mutation diseases (see analysis index), factor II-mutation, antithrombin III and, if necessary, cardiolipin antibodies is essential. Especially in case of conspicuous personal or familial thrombosis anamnesis, these evaluations are indicated. This is also the case when the patient receives treatment with estrogen-gestagen-combinations with tamoxifen or raloxifen. Influence of factor V-mutation and taking of ovulation inhibitors on the thrombosis risk: Please refer to table 2 Thrombophilia diagnostics and prophylaxis during pregnancy: In case of asymptomatic patients with factor V-mutation of the heterozygote type, administering heparin is generally not required. If there is venous thrombosis in the personal anamnesis, especially in connection to an earlier pregnancy or to administering oral contraceptives, then the prophylactic administering of low-molecular heparin and acetylic salicylic acid (110 mg/day) is indicated. In case of thrombosis during pregnancy, heparinization until giving birth and postpartum anticoagulants for 4-6 weeks are indicated. Side effects of heparin treatment: Osteoporosis, bleeding, heparin-induced thrombocytopenia (HIT type II). Frequency of hereditary and acquired causes for increased risk of venous thrombosis: Please refer to table 3 Please note, that in patients with first-time venous thrombosis, the most evident thrombophilia factors are factor V- and II-mutations, antiphospholipid syndrome and Hyperhomocysteinemia. The presence of two or more thrombosis risk factors is often decisive for the occurrence of clinical manifestations. 15 % of patients with thromboembolisms have multiple risk factors, which can lead to a significant risk increase. Despite the listed thrombophilia factors mainly leading to venous thrombosis, there may also be arterial thrombosis (i.e. in hyperhomocysteinemia). In addition to deep vein thrombosis in the legs, other locations such as cerebral vessels or placental vessels are possible.
Please refer to section “Atherosclerosis risk” In addition: Homocysteine (sodium fluoride plasma), cardiolipin-antibodies, factor II (prothrombin)-mutation with PCR (EDTA blood), lipoprotein (a), apolipoprotein-E-genotyping, exclusion of myeloproliferative disease. In case of coronary heart disease or stroke before the age of 45-50, evaluations for factor V- and II-mutations and protein-S-evaluation may be useful, especially, if there are other risk factors such as smoking, obesity, hypertension or diabetes. Thrombotic microangiopathy: 2 types
Table 1: I_thromb_1
Table 2: I_thromb_2008
Table 3: Thromb2
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