2004可疑高凝状态的研究(英文)-加拿大血栓小组.docVIP

2004可疑高凝状态的研究(英文)-加拿大血栓小组.doc

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2004可疑高凝状态的研究(英文)-加拿大血栓小组

Principal Developer: M. Mant Secondary Developers: D. Houston, L. Vickars Hypercoagulable/Thrombophilic States BACKGROUND Hypercoagulable states, also referred to as thrombophilias or prothrombotic disorders, are disorders that predispose a patient to venous, and sometimes to arterial, thromboembolism. Identification of such conditions may indicate a need for aggressive prophylaxis during high-risk periods, a need for prolonged treatment after an initial episode of thromboembolism, avoidance of oral contraceptives, and investigation of asymptomatic family members when a familial disorder is identified. A prothrombotic disorder should be considered in patients as outlined below. On the other hand, an indiscriminate search for underlying hypercoagulable states is usually unrewarding and may result in false positive results that inappropriately label patients as clotters. Some hypercoagulable states are associated with late fetal and recurrent pregnancy loss, intrauterine growth retardation and probably other obstetric complications. This guideline will not address this area further as it is rapidly evolving and best management in most situations cannot yet be defined. ACQUIRED CAUSES Most acquired causes of a predisposition to venous thromboembolism (VTE) can be elicited from the history and physical examination. Transient or reversible causes include immobilization, trauma or major surgery, use of oral contraceptives, hormone replacement therapy, and prolonged travel. Causes that are generally irreversible include malignancy, myeloproliferative disorders, nephrotic syndrome, antiphospholipid syndrome, malignancy, and paroxysmal nocturnal hemoglobinuria. Long term anticoagulation should be undertaken, or at least considered, in patients whose thrombotic event is associated with continued immobilization or any of the irreversible acquired causes. INHERITED CAUSES These include deficiencies of antithrombin, protein C and protein S; elevated Factor VIII; Factor V Leide

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