Diagnosis. Indications for testing are history of VTE or first-degree relative with
high-risk thrombophilia or VTE age <50 years.
Treatment. Anticoagulation options:
Inherited thrombophilias to test for include factor V Leiden (FVL)
mutation, prothrombin gene mutation (PGM) G2021 OA, protein C
deficiency (PCD), protein S deficiency (PSD), and antithrombin deficiency
(ATD).
High risk thrombophilias include homozygous FVL or PGM; compound
heterozygote FVL and PTM; and all ATD.
Low risk thrombophilias include heterozygous FVL or PGM; and all
PCD & PSD.
Acquired thrombophilias to test for include antiphospholipid syndrome
(APS). One or more of the following three antiphospholipid antibodies must
be positive on ≥2 occasions at least 12 weeks apart.Lupus anticoagulant
Anticardiolipin antibody (lgG & IgM)
Anti-β 2 -glycoprotein 1 (lgG & IgM)Unfractionated heparin (UFH) can be used antepartum & postpartum.
Advantages: inexpensive, can be reversed with protamine sulfate
Disadvantages: cannot use orally, short half-life, needs monitoring with
aPTT levels, heparin-induced osteopenia, heparin-induced
thrombocytopenia (HIT)
Low molecular weight heparin (LMWH) can be used antepartum &
postpartum.
Advantages: longer half-life, less need for monitoring with antifactor Xa