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Effect of anticoagulant therapy on the hypercoagulable state in patients carrying the factor V Arg506Gln mutation.

Resistance to activated protein C, caused by a single point mutation in the factor V gene (Arg506Gln or FV Leiden), is the most prevalent single risk factor associated with venous thromboembolic disease. The aim of this study was to investigate the effectiveness of standard oral anticoagulant therapy (OAT) in patients with the Arg506Gln mutation compared with a matched control group. The study compared selected variables in 27 patients carrying the Arg506Gln mutation with 27 sex- and age-matched controls in steady state oral anticoagulant treatment (OAT). The study showed that similar doses of vitamin K antagonists in carriers and noncarriers suppress and generate a uniform distribution of coagulation markers in steady state OAT. Thus, it seems that OAT with standard treatment doses is just as effective in patients with the Arg506Gln mutation as in comparable controls without the mutation.

Activated Protein C Resistance↗

Post-traumatic membranous obstruction of the inferior vena cava associated with a hypercoagulable state.

It has been hypothesized that abdominal trauma may be one of the factors involved in membranous obstruction of the inferior vena cava. We present two cases of membranous obstruction of the inferior vena cava associated with trauma. One asymptomatic case, associated with an occult myeloproliferative disorder, developed within 3 years of a violent abdominal trauma. The other case, associated with familial plasminogen deficiency, was discovered at surgery 3 days after a road accident with obvious abdominal trauma, since superimposed extensive thrombosis of the inferior vena cava caused acute Budd-Chiari syndrome. We conclude that underlying prothrombotic conditions are probably necessary for the development of membranous obstruction of the inferior vena cava and that minor trauma may contribute to the development of thrombosis through indirect mechanisms.

Adolescent↗

Clinical evaluation of hypercoagulable states.

Although thromboembolic disease associated with primary thrombophilic conditions most often presents before age 50 years, older adults can be affected by such disorders. This article addresses congenital and acquired prothrombotic states, with specific attention to the likelihood of such disorders occurring in the geriatric patient population. Recommendations for testing and therapy are reviewed.

Aged↗

Activated protein C resistance (FV(Leiden)) and thrombosis: factor V mutations causing hypercoagulable states.

The integrity of the vascular system is of prime importance for survival. Therefore, several emergency and repair systems safeguard the circulatory system. Multiple processes jointly limit vascular damage and blood loss. In this article, the authors focus on the protein C anticoagulant pathway and the role of activated protein C resistance in thrombotic disease, and they discuss the involvement in thrombosis of mutations other than the Arg506Gln mutation in the gene encoding for factor V.

Activated Protein C Resistance↗

Undiagnosed hypercoagulable state: a case study.

Vascular nursing presents constant challenges. The natural history of vascular disease coupled with the complexity of the patient population provides an environment for constant learning. Providing care to these unique individuals demands a thorough knowledge of vascular anatomy and physiology, diagnostic interventions, treatment modalities, multidisciplinary resources, and nursing interventions. This case study explores the multifaceted realm of vascular nursing by examining the hospital course and multidisciplinary plan of care of a 22-year-old man whose hospital course began with a lower extremity deep venous thrombosis and progressed to pulmonary embolus, phlegmasia cerulea dolens, compartment syndrome, sepsis, arterial thrombosis, severe coagulopathy, priapism, laryngeal bleeding/laryngospasm, and subsequent notification of having received a unit of blood from a donor whose human immunodeficiency virus status was later determined to be positive. The intent of this article is not to define a specific means of practice but to share with colleagues the wealth of knowledge that was gained from this experience.

Adult↗

Hypercoagulable states in patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) patients have an increased risk for venous thromboembolism, mainly portal venous thrombosis (PVT). The aim of this study was to assess the role of acquired and hereditary thrombotic risk factors in HCC patients. Thirty-one patients with HCC, 30 patients with cirrhosis but without HCC or PVT, and 48 matched healthy controls were studied. Mean levels of plasma protein C, protein S, antithrombin, and serum lipoprotein (a) were significantly lower in patients with HCC and in the cirrhotic group compared to the healthy controls. Mean serum homocysteine levels were significantly higher in patients with HCC compared to cirrhotics and healthy controls. The prevalence of activated protein C resistance, factor V Leiden mutation, prothrombin gene mutation G20210GA, and C677T methylenetetrahydrofolate reductase polymorphism was not significantly different among the three groups. In conclusion, thrombophilic defects are common in HCC patients and they might contribute to the observed thrombotic complications in this malignancy.

Adult↗

Association between pulmonary microthromboembolism and coagulation variables in hypercoagulable states: an autopsy study.

OBJECTIVE: This autopsy study was carried out to investigate the relationship between the number of pulmonary microthromboemboli and coagulation tests in patients with coagulation abnormalities. METHODOLOGY: Fifty-one patients in whom coagulation studies were performed within 2 days prior to death were studied. The coagulation tests included platelet counts, prothrombin times expressed as International Normalized Ratios (INR), activated partial thromboplastin times, fibrinogen concentrations, plasma fibrinogen/fibrin fragment E antigen levels, and plasma D-dimer levels. For microscopic analysis, five tissue blocks of the lung were taken from each subject and the number of pulmonary microthromboemboli per 20 cm2 of tissue sections was calculated. RESULTS: Thirty-six of the 51 patients had pulmonary microthromboembolism. International Normalized Ratios were higher than 1.7 in 12 of 36 embolic and in two of 15 non-embolic patients (33.3% of sensitivity and 86.7% of specificity). There was no significant difference in D-dimer levels between the two groups. Multiple regression analysis identified that INR was significantly related to the number of microthromboemboli (P = 0.042). CONCLUSIONS: D-dimer levels appear to be inappropriate as a single screening test for disseminated intravascular coagulation (DIC) in critically ill patients because the levels in these subjects are elevated irrespective of the presence of microthromboemboli. Because of the high specificity, INR could be a specific marker for microthromboemboli. The significant association between the number of microthromboemboli and INR might indicate the importance of the extrinsic pathway in the initiation of DIC.

Aged↗