Hypercoagulable Disorders

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Your doctor can work with you to lower your risk of developing recurrent blood clots. Measures may include losing weight, working to lower elevated homocysteine levels with vitamins B12 and folate, avoiding the use of oral contraceptives if you have other inherited or acquired risk factors, and avoiding situations that cause immobilization.

Regardless of the cause, the treatment for an acute thrombosis is often fairly standard. It usually consists of short term heparin (or, more commonly, low-molecular weight heparin) anticoagulant therapy, followed by an overlap of heparin and warfarin (coumadin) therapy, followed by several months or longer of warfarin (coumadin) therapy. During this treatment regimen, unfractionated (standard) heparin is monitored using the PTT test or heparin assay, and warfarin (coumadin) therapy is monitored with the international normalized ratio (INR). After several months of warfarin (coumadin), your doctor may evaluate your risk of clot recurrence. The doctor must weigh the risk of recurrent clotting against the very real risk of bleeding episodes with continued anticoagulation. If you are at a high risk of recurrent clotting, anticoagulant therapy may be continued indefinitely. If you are at a lower risk, the anticoagulant will most likely be discontinued but you will need to be vigilant, going back to your doctor promptly if thrombotic symptoms return.

Those who are on continued anticoagulant therapy will have to plan ahead, with the help of their doctor, when they require procedures and surgeries. These usually involve taking the patient off of their anticoagulant for a short period of time prior to their surgery. However, current recommendations suggest that warfarin does not need to be held for dental procedures. Following surgery, most patients, including those who do not have known hypercoagulable disorders, will receive a course of preventative anticoagulation. This is especially true after procedures such as knee replacement surgery that may increase a patient’s risk of clotting, either because of the nature of the surgery itself or because of immobilization and an extended recovery after the surgery.

Patients who are pregnant and have a blood clot will usually receive subcutaneous (under the skin) anticoagulation with low-molecular weight heparin. Patients who have antithrombin deficiencies may benefit from antithrombin factor replacement when they cannot take anticoagulant therapy (for example, around the time of surgery). Protein C concentrates can be used to temporarily replenish protein-C deficiencies, and aspirin therapy (which affects platelet function) may be useful in some instances.

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