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Chapter 7
Thrombosis and thrombophilia
This chapter gives an overview of the pathophysiologic contributors to thrombosis; describes the mechanisms, epidemiology, testing issues, and clinical relevance of inherited and acquired thrombophilias; discusses the drugs used as anti-thrombotics; and reviews various clinical, diagnostic, and therapeutic aspects of thrombosis.
Pathophysiology of thrombosis
Thrombosis, defined as excessive clotting, has 3 main causes, referred to as Virchow's triad: reduced blood flow (stasis), blood hypercoagulability, and vascular wall abnormalities. Blood in the vasculature is kept in a fluid state by the delicate balance of multiple procoagulant and anticoagulant factors (ie, coagulation proteins [coagulation factors], platelets, leukocytes, erythrocytes, and components of the vessel wall). If
Thrombophilias
Factor V Leiden General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Prothrombin 20210 mutation General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Protein C deficiency General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Protein S deficiency General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Antithrombin deficiency General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Antiphospholipid antibodies General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Factor VIII elevation General information Prevalence Testing Risk for thrombosis Management Pediatric considerations Homocysteine and methylenetetrahydrofolate reductase General information Prevalence Testing issues Risk for thrombosis Management Myeloproliferative disorders General information Splanchnic vein thrombosis and JAK2 V617F mutation Other VTEs and JAK2 V617F mutation Paroxysmal nocturnal hemoglobinuria General information Management Abnormalities in fibrinolysis Plasminogen Tissue plasminogen activator Plasminogen activator inhibitor-1 Thrombin-activatable fibrinolysis inhibitor Other factors Lipoprotein(a) Family history of VTE Others Acquired conditions Cancer Contraceptive pills and patches Other conditions Whom to test Consensus guidelines Reasons to test or not test Authors' approach The adult hematologist's approach (S.M.) The pediatric hematologist's approach (J.J.) Interpreting test results and educating patients
Antithrombotic drugs
Antiplatelet agents Aspirin Phosphodiesterase inhibitors Dipyridamole Cilostazol Pentoxifylline Adenosine diphosphate receptor antagonists Clopidogrel and ticlopidine Prasugrel GPIIb/IIIa receptor antagonists Abciximab Eptifibatide Tirofiban Oral GPIIb/IIIa antagonists Pediatric considerations Anticoagulants Heparins Mechanism of action Management of bleeding Heparin-induced thrombocytopenia Heparin resistance Unfractionated heparin Low molecular weight heparin Fondaparinux Thrombin inhibitors Hirudins Argatroban Vitamin K antagonists Mechanism of action Monitoring and dose requirement Available oral anticoagulants Management of elevated INRs and bleeding Periprocedural interruption of oral anticoagulant therapy Pediatric considerations Drugs in development Thrombolytic agents
Venous thromboembolism
Superficial thrombophlebitis Deep vein thrombosis and pulmonary embolism Prevention Symptoms Diagnosis Acute therapy Duration of anticoagulant therapy Postthrombotic syndrome Pulmonary hypertension Inferior vena cava filters Venous stents Unusual venous thromboses Upper extremity DVT Catheter-related thrombosis Hepatic vein thrombosis Portal vein thrombosis Mesenteric vein thrombosis Splenic vein thrombosis Cerebral and sinus vein thrombosis Renal vein thrombosis Retinal vein thrombosis
Arterial thromboembolism
General comments Arterial thrombosis in the absence of arteriosclerosis Peripheral arterial disease Atrial fibrillation and stroke prevention Neonatal stroke Childhood stroke   CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter What's this?
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