Hypercoagulable States and Thrombophilias: Risks Relating to Recurrent Venous Thromboembolism

Rybstein, Marissa; DeSancho, Maria T.

doi:10.1055/s-0038-1642037

Cited by 14 publications

(12 citation statements)

References 35 publications

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“… 10 Acquired thrombophilia includes antiphospholipid syndrome (APS), among other autoimmune disorders such as Behcet's disease. 11 The primary instance in which testing for thrombophilia leads to a change in treatment is the presence of APS, for which warfarin is recommended rather than a direct oral anticoagulant (DOAC). 12 The presence of APS is furthermore distinguished from the significant determination of provoked versus unprovoked VTEs.…”

Section: Discussionmentioning

confidence: 99%

“…There are differing opinions regarding anticoagulation and thrombophilia, since the literature is unclear if they confer a higher risk of recurrence. 11 Some, such as Stevens et al, recommended not performing thrombophilia testing following an episode of provoked VTE, as a positive test is not enough to determine the duration of anticoagulation and may subject patients to otherwise avoidable bleeding risks. 8 They also reported that thrombophilia testing should not be performed in patients after a single episode of unprovoked VTE because a negative result is not enough to stop anticoagulation in a patient with low bleeding risk and willingness to continue therapy.…”

Section: Discussionmentioning

confidence: 99%

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Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center

Alidoost

Conte

Gupta

et al. 2021

JBM

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Background Venous thromboembolism is a significant clinical event, with an annual incidence of 1–2 per 1000 population. Risk factors include recent surgery, prolonged immobility, oral contraceptive use, and active cancer. Inherited risks include protein C and S deficiencies, antithrombin deficiency, factor V Leiden mutation and prothrombin. These factors can be tested to guide therapy, but current evidence suggests that testing for inherited thrombophilia is not recommended in most inpatient settings. In the era of high value care, hypercoagulable testing for VTE creates a financial burden for the hospital and patients. We performed a retrospective chart review of hypercoagulable orders on VTE patients at our institution. Methods Institutional Review Board approval was obtained. A total of 287 adult patients admitted over a 3-month period with the diagnosis of VTE were included. Patients were identified via ICD-10 codes and data were collected from electronic medical records. Patient characteristics, provoked versus unprovoked VTE, and relative contraindications for hypercoagulability work-up were analyzed. Our primary outcome was to assess the appropriateness of thrombophilia testing in VTE patients based on screening guidelines. Our secondary outcome was to analyze the cost burden of ordering these tests. Results A total of 287 patients were included in our data analysis. Patient risk factors for VTE were malignancy, previous DVT, immobilization, surgery 3 months prior, and central line placement. Fifty-seven of 287 patients had at least one hypercoagulable test ordered during hospitalization which did not adhere to guidelines. Misuse of testing occurred during active thrombosis, active anticoagulation, presence of risk factors, first episode of VTE, and malignancy. The cost of ordering these 5 thrombophilia tests totaled over $40,000. Conclusion In our study, numerous patients were tested without compliance to standard recommendations, which created financial and value-based burdens on our health care system. Increased awareness among clinicians is thus warranted to ensure high value care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center

Alidoost

Conte

Gupta

et al. 2021

JBM

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“…The extent of influence of inherited thrombophilia on the risk of VTE recurrence remains controversial[ 10 ]. In our cohort, stent patency and re-intervention rates were not significantly different between thrombophilia positive and negative patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens

Cramer¹,

Mensah²,

DeSancho³

et al. 2021

WJR

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BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease. Iliac stent patency is multifactorial, and current management is based on best clinical practices, varying by institution. AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes. METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein (CIV) stenting between December 2013 and December 2019 at a large academic center. Search criteria included CIV stenting and iliac vein compression. Non-thrombotic lesions and iliocaval thrombosis and/or occlusions were excluded. A total of 65 patients were selected for final analysis. Demographic information, procedural data points, and post-procedural management and outcomes were collected. Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients. RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting. Of these patients, 33 (50.8%) underwent thrombophilia testing, with 16 (48.5%) testing positive. Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo (92.3% vs 81.3%, P = 0.6), 6 mo (83.3% vs 80%, P > 0.9), or 12 mo (77.8% vs 76.9%, P = 0.8). Immediately after stent placement, thrombophilia patients were more likely to be placed on dual therapy (aspirin and anticoagulation) or triple therapy (aspirin, clopidogrel, and anticoagulation) (50% vs 41.2%, P > 0.9), and remain on dual therapy at 6 mo (25% vs 12.5%, P = 0.5) and 12 mo (25% vs 6.7%, P = 0.6). There was no significant difference in re-intervention rates (25% vs 35.3%, P = 0.7) or number of re-interventions (average 2.3 vs 1.3 per patient, P = 0.4) between thrombophilia positive and negative patients. CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive. The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.

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“…Trauma patients with thrombosis need not be routinely examined for hereditary thrombophilia [ 61 ]. In contrast, thrombotic events are 2–20 times more likely to occur in trauma patients with other types of thrombophilia [ 62 ], so thrombophilia testing is recommended for patients with recurrent post-traumatic thromboembolism or family history of thrombotic disease [ 63 ] (Table 1 ).…”

Section: Pathophysiological Mechanismmentioning

confidence: 99%

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

Song¹,

Yang²,

Zhao

et al. 2021

Military Med Res

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Trauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2–85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People’s Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.

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Hypercoagulable States and Thrombophilias: Risks Relating to Recurrent Venous Thromboembolism

Cited by 14 publications

References 35 publications

Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center

Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center

Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

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