Thrombophilia

increased tendency for person to develop clood clots

thrombotic risk = accumulation of factors

Virchow’s triad

• circulatory stasis

  • AF

  • LV dysfunction

  • immobility/paralysis

  • venous insufficiency/varicose veins

  • venous obstruction: tumour, obesity, pregnancy

• hypercoagulability

  • malignnacy

  • pregnancy/peripartum

  • oestrogen

  • trauma/surgery

  • IBD

  • nephrotic syndrome

  • sepsis

  • thrombophilia

• vascular wall injury

  • trauma/surgery

  • venepuncture

  • chemical irritation

  • heart valve disease/replacement

  • atherosclerosis

  • indwelling catheters

risk factors for VTE

• strong (OR >10)

  • fracture (hip or leg)

  • hip or knee replacement

  • major general surgery

  • major trauma

  • spinal cord injury

• Moderate (OR 2-9)

  • Arthroscopic knee surgery

  • Central venous lines

  • chemotherapy

  • CHF/Resp failure

  • HRT

  • malignancy

  • COCP

  • paralytic stroke

  • pregnancy/postpartum

  • previous VTE

  • inherited thrombophilia

• Weak (\<2)

  • bed rest >3d

  • immobility

  • increase age

  • laparoscopic surgery

  • obesity

  • pregnancy

  • varicose veins

testing rarely indicated

• specific situations where ‘results alter managements’

  • people presenting @ young age with unprovoked venous thrombosis

    • \<40yo

  • positive fami ly history

    • 2 or more symptomatic first degree family members

  • children with purpura fulminans

    • progressive haemorrhagic skin necrosis

    • Protein C & S deficiency

  • some pregnant women

• thrombopihilia screen

  • Factor V leiden

  • prothrombin gene mutation

  • antithrombin

  • Protein C and protein S

  • lupus anticoagulant screen

don’t test:

• in acute phase of thrombotic event

• Family history for thrombosis

  • FV leidien and prothrombin gene mutation = low risk

• taking oestrogen containing hormone preparations