Hypercoagulability and Thrombosis

Bick, Rodger L.; Ucar, Kalust

doi:10.1016/s0889-8588(18)30284-3

Cited by 50 publications

(26 citation statements)

References 35 publications

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“…72 The thrombotic risk associated with these antibodies, particularly in young, otherwise healthy subjects, is also unclear, but thromboembolism rates of 6% to 8% in otherwise healthy patients with lupus anticoagulant have been reported. 73 In a case-control analysis involving participants in the Physicians Health Study, those with anticardiolipin antibody titers above the 95 th percentile had a 5.3-fold increased risk of developing DVT or PE over a 5-year period. 74 Prior thrombosis, a lupus anticoagulant, and elevation of the IgG idiotype anticardiolipin antibodies have all been suggested to increase the risk of thrombosis.…”

Section: Antiphospholipid Antibody Syndromementioning

confidence: 99%

Risk Factors for Venous Thromboembolism

2003

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Abstract-Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illnesses have demonstrated a risk of VTE in medical patients comparable with that seen after major general surgery. In addition, epidemiologic studies have shown that between one quarter and one half of all clinically recognized symptomatic VTEs occur in individuals who are neither hospitalized nor recovering from a major illness. This expanding understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who could benefit from prophylaxis. Factors sufficient by themselves to prompt physicians to consider VTE prophylaxis include major surgery, multiple trauma, hip fracture, or lower extremity paralysis because of spinal cord injury. Additional risk factors, such as previous VTE, increasing age, cardiac or respiratory failure, prolonged immobility, presence of central venous lines, estrogens, and a wide variety of inherited and acquired hematological conditions contribute to an increased risk for VTE. These predisposing factors are seldom sufficient by themselves to justify the use of prophylaxis. Nevertheless, individual risk factors, or combinations thereof, can have important implications for the type and duration of appropriate prophylaxis and should be carefully reviewed to assess the overall risk of VTE in each patient. Key Words: thrombus Ⅲ risk factors Ⅲ prevention Ⅲ embolism V TE consists of 2 related conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). This review summarizes the strength of the evidence regarding specific risk factors for VTE and provides a guide for identifying patients who could benefit from VTE prophylaxis. This article also identifies population groups whose apparent risk for VTE is too low to justify preventive treatment.In 1884, Rudolph Virchow first proposed that thrombosis was the result of at least 1 of 3 underlying etiologic factors: vascular endothelial damage, stasis of blood flow, and hypercoagulability of blood. In the last century, recognition that all DVT risk factors reflect these underlying pathophysiologic processes and that VTE does not usually develop in their absence has increased. In a review of 1231 consecutive patients treated for VTE, 96% had Ն1 recognized risk factor (Table 1). 1 Furthermore, there is convincing evidence that risk increases in proportion to the number of predisposing factors (Figure 1). 2,3 The majority of clinically recognized instances of VTE are suspected because of typical signs and symptoms in individuals who present to an outpatient clinic or hospital emergency department; 1 only one quarter to one half of VTE are diagnosed in patients who are or were recently hospitalized. 1,4,5 Risk factors convincingly demonstrated for VTE include increasing age, prolonged immobility, malignancy...

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Section: Antiphospholipid Antibody Syndromementioning

confidence: 99%

Risk Factors for Venous Thromboembolism

2003

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“…It is now known that patients with systemic lupus or other autoimmune diseases may develop an immunoglobulin that has the ability to prolong phospholipid-dependent coagulation tests [13,14]. Approximately 10% of patients with systemic lupus harbor an LA; however, the LA commonly is seen in other conditions as well, including malignancy, lymphoproliferative disorders, and viral infections, especially human immunodeficiency virus infection [15 -17].…”

Section: Lupus Anticoagulants and Thrombosismentioning

confidence: 99%

“…A common misconception is that patients with drug-induced LA, usually IgM idiotype, do not have thrombosis, but in fact these patients also have an increased risk of thrombotic disease. The frequency of hemorrhage resulting from the LA is clearly less than 1%; however, it is important to recognize conditions that may predispose patients with lupus harboring an LA to hemorrhage [21,22]. Twenty-five percent of patients with systemic lupus have concomitant prothrombin deficiency, and more than 40% may have thrombocytopenia; these accompanying defects are noted particularly in those with secondary LA-thrombosis syndromes [21,23].…”

Section: Lupus Anticoagulants and Thrombosismentioning

confidence: 99%

“…Of interest, biologic false-positive test results for syphilis are seen in up to 40% of patients with systemic lupus; the number increases to 90% in patients with systemic lupus plus the LA [22,25,31]. An abnormality often (theoretically) exists in the phospholipiddependent coagulation reactions, including the prothrombin time, the activated partial thromboplastin time (aPTT), and the Russell's viper venom time because the LA is not directed against a specific factor but to phospholipids.…”

Section: Lupus Anticoagulants and Thrombosismentioning

confidence: 99%

“…The assays are based on the use of limiting amounts of phospholipid, and therefore are sensitized in platelet-poor plasma. Initially, a prothrombin time was performed with dilute tissue thromboplastin and a reduced number of platelets in the mixture; however, IgM inhibitors were missed [22]. A ''modified'' Russell's viper venom time was developed in which the venom was diluted to give a ''normal'' time of 23 to 27 seconds, and the phospholipid then was diluted down to a minimal level that continued to support this range.…”

Section: Lupus Anticoagulants and Thrombosismentioning

confidence: 99%

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