Thomas G. DeLoughery, MD, FACP, FAWM

Oregon Health Sciences University, Portland, OR

This case was reviewed and updated in October 2012 by Dr. Alvin H. Schmaier and members of the Teaching Cases Subcommittee.

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.


Three things to remember about coagulation
  • Initiated by exposure of tissue factor
  • Propagated by formation of thrombin
  • Cross-linked fibrin formation via thrombin and factor XIII
Four clues to a hypercoagulable state
  • Thrombosis at an early age
  • Recurrent thromboses
  • Thrombosis at an unusual site
  • Family history of thrombosis
Five most common inherited prothrombotic states
  • Factor V Leiden
  • Hyperhomocysteinemia
  • Prothrombin gene mutation
  • Protein S deficiency
  • Protein C deficiency
At least five acquired hypercoagulable states
  • Estrogen excess (oral contraceptives, pregnancy)
  • Malignancy
  • Antiphospholipid antibodies
  • Inflammatory Bowel Disease
  • Nephrotic syndrome

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