hypercoagulable state

Question 1

What commonly used medication is known to increase the risk of thrombotic events?

Answer 1

oral contraceptives

Question 2

What is Virchow’s triad?

Answer 2

• stasis
• hypercoagulable state
• endothelial trauma

Question 3

If someone comes in with an acute thrombosis what 4 hypercoagulable disorder tests cannot be done?

Answer 3

• Protein C
• Protein S
• Lupus anticoagulant
• Antithrombin (AT) deficiency

Question 4

Which 2 of the thrombophilia disorders can be arterial?

Answer 4

• Antiphospholipid Syndrome (APS)

- hyperhomocysteinemia

Question 5

What is the step wise process in evaluating a embolic event? (5 steps)

Answer 5

• EKG/telemetry
• vascular U/S
• hypercoagulable laboratory eval
• TEE
• Chest CT

Question 6

How is APS diagnosed using the Sydney Criteria?

Answer 6

Need to have either:

• Vascular thrombosis
• Pregnancy morbidity

AND 1+ of the following need to be positive 2x >12 weeks apart:

• anticardiolipin antibodies (aCL)
• anti-beta2-glycoprotein-I antibodies (aB2GPI)
• lupus anticoagulant (LA) test

Question 7

What are the 5 inherited thrombophilia disorders?

Answer 7

• factory V leiden mutation
• prothrombin G gene mutation
• Protein S deficiency
• Protein C deficiency
• Antithrombin deficiency

Question 8

Testing for which of the thrombophilia disorders is not recommended?

Answer 8

hyperhomocysteinemia

Question 9

When do you consider performing a JAK2 mutation test?

Answer 9

thrombosis in unusual vascular bed (portal, hepatic, mesenteric)

Question 10

The first thing you look for when evaluating for Factor V leiden mutation is what?

Answer 10

activated protein C

*Factor V Leiden makes Factor V insensitive to protein C

Question 11

All of the inherited thrombophilia disorders are associated with what type of thrombosis?

Answer 11

venous

Question 12

Which study might be prolonged in lupus anticoagulant?

Answer 12

PTT

Question 13

In which 8 situations would you evaluate for a hypercoagulable state?

Answer 13

• unprovoked VTE age <45
• unprovoked VTE with FMx
• recurrent events
• thrombosis in unusual vascular bed
• warfarin necrosis
• findings for malignancy
• risk for malignancy
• strong FMx VTE

Question 14

In these 7 situations evaluating for a hypercoagulable state is not recommended

Answer 14

• first unprovoked VTE
• active malignancy
• IBS
• myeloproliferative disorder
• heparin induced thrombocytopenia with thrombosis
• retinal vein thrombosis in setting of preeclampsia
• unselected screening

Question 15

for first time unprovoked VTE what is the duration of VKA therapy?

Answer 15

3 months

6 months for secondary prophylaxis of VTE

Question 16

recurrent miscarriages warrants what test?

Answer 16

-antiphospholipid syndrome (APS) test

Question 17

What 2 hypercoagulable disorders cannot be measured if a patient is on warfarin?

Answer 17

• Protein C deficiency

- Protein S deficiency

Question 18

What 2 hypercoagulable disorders cannot be measured if a patient is on heparin?

Answer 18

• Antithrombin (AT) deficiency

- Lupus anticoagulant

Question 19

In an acute thrombosis what 2 hypercoagulable disorders can be lowered?

Answer 19

• Protein S deficiency

- Antithrombin (AT) deficiency