Congenital and acquired hypercoagulable syndromes

A clear understanding of the various conditions and situations in which a patient may have a hypercoagulable state is important for the ability to manage and appropriately treat patients in whom the risk of thrombosis exists. Once that risk is recognized, appropriate observation, prophylaxis, and treatment may ensue. It must be recognized that the number of acquired disease processes that predispose patients to thrombosis far outweighs the number of patients with congenital thrombophilias. Although a large portion of the population may have a thrombosis, few thromboses are caused by an inherited thrombophilia alone. The objectives of treating acute venous thromboembolism include the prevention of death from pulmonary embolism, reduction of lower-extremity symptoms, prevention of postphlebitic syndrome, and prevention of recurrent venous thromboembolism. By limiting the propagation of thrombus, anticoagulation potentially has a role in achieving all of these objectives. Initial anticoagulation with unfractionated heparin or low-molecular-weight heparin, followed by six weeks to six months of oral vitamin K antagonists has been the mainstay of therapy.