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Symptoms and Signs – Differential Diagnosis of Acquired Hypercoagulable State
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
• Most common cause of acquired thrombophilia
• Can present as arterial or venous thrombosis, recurrent pregnancy loss, and adverse pregnancy outcomes
• Thromboembolic events occur in up to 30% of population; high risk of recurrent thrombosis (up to 70% reported).
HYPERHOMOCYSTEINEMIA
• Can be inherited (most commonly an autosomal recessive mutation in methylene tetrahydrofolate reductase gene) but more frequently acquired; folate, vitamin B6, or vitamin B12 deficiency accounts for two thirds of cases. Other acquired causes include renal disease, hypothyroidism, malignant disease, smoking, and certain medications.
• May be associated with venous thromboembolism (VTE), atherosclerotic disease (cardiovascular, cerebrovascular, and peripheral vascular), and possibly adverse pregnancy outcomes
CONDITIONS ASSOCIATED WITH INCREASED RISK OF THROMBOSIS
• Prior thrombosis
• Trauma
• Medical illness: heart failure, respiratory failure, infection, diabetes mellitus, obesity, nephrotic syndrome, inflammatory bowel disease, paroxysmal nocturnal hemoglobinuria, sickle cell anemia
• Pregnancy (sixfold increased risk of VTE), post partum, OC use (fourfold increased risk, higher risk with third-generation OCs), transdermal contraceptive patch, HRT (twofold increased risk), tamoxifen, raloxifene
• Immobilization, travel
• Surgery (especially orthopedic), central venous catheters
• Hyperviscosity syndromes
• Myeloproliferative disorders
• Malignancy: disease or treatment related
• Heparin-induced thrombocytopenia and thrombosis
• Smoking
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
• Most common cause of acquired thrombophilia
• Can present as arterial or venous thrombosis, recurrent pregnancy loss, and adverse pregnancy outcomes
• Thromboembolic events occur in up to 30% of population; high risk of recurrent thrombosis (up to 70% reported).
HYPERHOMOCYSTEINEMIA
• Can be inherited (most commonly an autosomal recessive mutation in methylene tetrahydrofolate reductase gene) but more frequently acquired; folate, vitamin B6, or vitamin B12 deficiency accounts for two thirds of cases. Other acquired causes include renal disease, hypothyroidism, malignant disease, smoking, and certain medications.
• May be associated with venous thromboembolism (VTE), atherosclerotic disease (cardiovascular, cerebrovascular, and peripheral vascular), and possibly adverse pregnancy outcomes
CONDITIONS ASSOCIATED WITH INCREASED RISK OF THROMBOSIS
• Prior thrombosis
• Trauma
• Medical illness: heart failure, respiratory failure, infection, diabetes mellitus, obesity, nephrotic syndrome, inflammatory bowel disease, paroxysmal nocturnal hemoglobinuria, sickle cell anemia
• Pregnancy (sixfold increased risk of VTE), post partum, OC use (fourfold increased risk, higher risk with third-generation OCs), transdermal contraceptive patch, HRT (twofold increased risk), tamoxifen, raloxifene
• Immobilization, travel
• Surgery (especially orthopedic), central venous catheters
• Hyperviscosity syndromes
• Myeloproliferative disorders
• Malignancy: disease or treatment related
• Heparin-induced thrombocytopenia and thrombosis
• Smoking
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