Elevated Hemostatic Factor Levels as Potential Risk Factors for Thrombosis

Abstract Objectives.—To review the state of the art relating to elevated hemostatic factor levels as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of specific measurements of hemostatic factor levels in the assessment of thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. Each of the key points and associated recommendations was then presented for discussion at the conference. Recommendations were accepted if a consensus of the 27 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 8 recommendations concerning the use of hemostatic factor levels in the assessment of thrombotic risk in individual patients. Detailed discussion of the rationale for each of these recommendations is presented in the article. This is an evolving area of research. While routine use of factor level measurements is not recommended, improvements in assay methodology and further clinical studies may change these recommendations in the future.

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Dysfibrinogenemia and Thrombosis

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-1387-dat ◽

2002 ◽

Vol 126 (11) ◽

pp. 1387-1390 ◽

Cited By ~ 5

Author(s):

Timothy Hayes

Keyword(s):

Medical Literature ◽

State Of The Art ◽

Data Extraction ◽

Initial Assessment ◽

Laboratory Evaluation ◽

Diverse Group ◽

Review Of The Literature ◽

Thrombotic Risk ◽

Routine Testing ◽

Key Points

Abstract Objectives.—To review the state of the art relating to congenital dysfibrinogenemia as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of laboratory assays for assessing this thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 5 conclusions and 2 recommendations concerning the use of testing for dysfibrinogens in the assessment of thrombotic risk in individual patients. Detailed discussion of the rationale for each of these recommendations is found in the text of this article. Compared with the other, more common hereditary thrombophilias, dysfibrinogenemia encompasses a diverse group of defects with varied clinical expressions. Congenital dysfibrinogenemia is a relatively rare cause of thrombophilia. Therefore, routine testing for this disorder is not recommended as part of the laboratory evaluation of a thrombophilic patient. This is an evolving area of research, and further clinical studies may change these recommendations in the future.

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Heparin Cofactor II Deficiency

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-1394-hcid ◽

2002 ◽

Vol 126 (11) ◽

pp. 1394-1400

Author(s):

Douglas M. Tollefsen

Keyword(s):

Medical Literature ◽

State Of The Art ◽

Data Extraction ◽

Thromboembolic Disease ◽

Data Sources ◽

Initial Assessment ◽

Insufficient Evidence ◽

Heparin Cofactor Ii ◽

Laboratory Methods ◽

Thrombotic Risk

Abstract Objectives.—To review of the state of the art relating to congenital heparin cofactor II deficiency as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of laboratory assays for assessing this thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, including review of clinical study design and laboratory methods, a draft manuscript was prepared and circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia. Recommendations were accepted if a consensus of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached that there is insufficient evidence to recommend testing for heparin cofactor II deficiency in patients with thromboembolic disease.

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College of American Pathologists Consensus Conference XXXVI: Diagnostic Issues in Thrombophilia

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-1277-coapcc ◽

2002 ◽

Vol 126 (11) ◽

pp. 1277-1280 ◽

Cited By ~ 8

Author(s):

John D. Olson

Keyword(s):

Clinical Studies ◽

Laboratory Testing ◽

Medical Literature ◽

State Of The Art ◽

Data Extraction ◽

Consensus Conference ◽

The State ◽

Data Sources ◽

Level Of Evidence ◽

Thrombotic Risk

Abstract Objectives.—To review the state of the art relating to laboratory testing for thrombophilia, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations regarding laboratory testing (whom to test, when to test, what tests to perform, rationale for testing, and other issues) in the assessment of thrombotic risk in individual patients and their family members. Data Sources.—Review of the medical literature (primarily from the last 10 years) and the experience and opinions of experts in the field were used as data sources. Data Extraction and Synthesis.—Participating authors evaluated the medical literature and prepared manuscripts with specific proposed recommendations. Drafts of all of the manuscripts were prepared and circulated to every participant in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. Each of the conclusions and associated recommendations was then presented for discussion. Recommendations were accepted if a consensus of 70% or more of the 27 experts attending the conference was reached. The results of the discussion were then used to revise the manuscripts and recommendations into final form. Conclusions.—Consensus was reached on 179 recommendations, all of which are presented in articles in this issue of the Archives. Detailed discussion of the rationale for each of these recommendations is found in the text of the respective articles, along with citations to justify the level of evidence for the recommendations. This is an evolving area of research, and it is certain that further clinical studies will change many of the recommendations, cause some to be deleted, and add others in the future.

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Hyperhomocyst(e)inemia and Thrombophilia

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-1367-hat ◽

2002 ◽

Vol 126 (11) ◽

pp. 1367-1375 ◽

Cited By ~ 3

Author(s):

Nigel S. Key ◽

Ronald C. McGlennen

Keyword(s):

Arterial Thrombosis ◽

Medical Literature ◽

Homocysteine Level ◽

Data Extraction ◽

Plasma Homocysteine ◽

Testing Methods ◽

Plasma Homocysteine Level ◽

Key Points ◽

Criteria For Diagnosis

Abstract Objective.—To review the role of an elevated total plasma homocysteine level (hyperhomocyst[e]inemia) in patients with venous or arterial thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—The literature was reviewed to identify key points defining the condition, and the clinical study design of each article was examined. A draft manuscript was prepared and circulated prior to the conference to every participant in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia. Each of the key points and associated recommendations was then presented for discussion at the conference. Recommendations were accepted if a consensus of the 70% of the experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 9 recommendations concerning the criteria for diagnosis, the method of testing, and the approach for clinical management. A major point of consensus was that no causal role of hyperhomocyst(e)inemia in venous or arterial thrombosis is yet established. Testing methods used to measure homocysteine directly are sensitive and reliable, and provide more information than does genotyping for markers linked to abnormal plasma homocysteine.

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Premature Arterial Disease Associated with Familial Antithrombin III Deficiency

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645677 ◽

1990 ◽

Vol 63 (01) ◽

pp. 013-015 ◽

Cited By ~ 15

Author(s):

E J Johnson ◽

C R M Prentice ◽

L A Parapia

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Potential Risk ◽

Antithrombin Iii ◽

Arterial Disease ◽

Coagulation System ◽

Early Age ◽

Arterial Thromboembolism ◽

Potential Risk Factors ◽

Antithrombin Iii Deficiency

SummaryAntithrombin III (ATIII) deficiency is one of the few known abnormalities of the coagulation system known to predispose to venous thromboembolism but its relation to arterial disease is not established. We describe two related patients with this disorder, both of whom suffered arterial thrombotic events, at an early age. Both patients had other potential risk factors, though these would normally be considered unlikely to lead to such catastrophic events at such an age. Thrombosis due to ATIII deficiency is potentially preventable, and this diagnosis should be sought more frequently in patients with arterial thromboembolism, particularly if occurring at a young age. In addition, in patients with known ATIII deficiency, other risk factors for arterial disease should be eliminated, if possible. In particular, these patients should be counselled against smoking.

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