Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Thrombophilia 1421

THROMBOPHILIA

MIGUEL A. ESCOBAR, MD; ALICE D. MA; MD and

HAROLD R. ROBERTS, MD

history & physical

Thrombophilia is a multi-causal condition in which genetic and

acquired risk factors interact increasing the risk of thrombosis.

Several features suggest the presence of a hypercoagulable state.

■Thromboembolism before age 45 y

■Family history of thrombosis

➣Idiopathic thromboembolism

■Recurrent thromboembolism

■Thrombosis in an unusual site

➣Warfarin-induced skin necrosis (protein C or S deficiency)

➣Neonatal purpura fulminans (homozygous protein C or protein

S deficiency)

Conditions predisposing to arterial and venous thrombosis are not

the same.

Congenital Conditions Predisposing only to Venous Thrombosis

■Factor V Leiden mutation

■Prothrombin gene mutation

■AT deficiency

■Protein C Deficiency

■Protein S Deficiency

Congenital Conditions Predisposing to Both Venous and Arterial

Thrombosis

■Dysfibrinogenemia

■Elevated levels of lipoprotein (a)

Acquired Conditions Predisposing only to Venous Thrombosis

■Pregnancy and puerperium

■Estrogen use

➣Thalidomide

➣Tamoxifen/Raloxifene

■Malignancy

■Trauma, surgery, immobility

➣Previous venous thrombosis

➣Nephrotic syndrome

■Congestive heart failure

■Hyperviscosity syndromes

■High levels of fibrinogen