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Hypercoagulable state

Last reviewed: 16 Aug 2025
Last updated: 06 Jun 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • calf swelling
  • pain or tenderness along deep venous system
  • chest pain
  • tachypnea
  • breathlessness
  • hypotension
  • tachycardia
Detalhes completos

Outros fatores diagnósticos

  • family history of venous thromboembolism (VTE)
Detalhes completos

Fatores de risco

  • history of unprovoked venous thromboembolism
  • increasing age
  • pregnancy/postpartum
  • obesity
  • smoking
  • malignancy
  • acute inflammatory state
  • antiphospholipid antibodies (aPLs)
  • myeloproliferative disorders
  • nephrotic syndrome
  • Behcet disease
  • HIV infection
  • disseminated intravascular coagulation
  • paroxysmal nocturnal hemoglobinuria
  • heparin-induced thrombocytopenia
  • estrogen-containing oral birth control pill/hormone replacement therapy/selective estrogen receptor modulator therapy
  • chemotherapy
  • surgery
  • long-haul flight (>4 hours)
  • antithrombin deficiency
  • protein C deficiency
  • protein S deficiency
  • plasminogen deficiency
  • elevated fibrinogen
  • dysfibrinogenemia
  • factor V Leiden
  • prothrombin gene mutation (G-20210-A; also referred to as F2 c.*97G>A variant)
  • elevated factor VIII levels (>150 U/L)
  • elevated levels of factor IX or XI
  • hyperhomocysteinemia
  • sickle cell disease
  • elevated levels of thrombin-activatable fibrinolysis inhibitor (TAFI)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CBC
  • peripheral blood smear
  • activated partial thromboplastin time (aPTT)
  • fibrinogen
  • prothrombin time (PT)
  • D-dimer
  • serum albumin
  • serum creatinine
  • serum cholesterol
  • serum triglycerides
Detalhes completos

Tests to avoid

  • homocysteine level
Detalhes completos

Investigações a serem consideradas

  • heritable thrombophilia test
  • polymerase chain reaction (PCR) for factor V Leiden
  • antiphospholipid antibodies (lupus anticoagulant, anticardiolipin antibodies, anti-beta-2 glycoprotein 1 antibodies)
  • factor VIII level
  • myeloproliferative neoplasm panel
  • flow cytometry for paroxysmal nocturnal hemoglobinuria
  • heparin-induced thrombocytopenia (HIT) test
  • chest x-ray
  • abdominal CT
  • abdominal ultrasound
  • tumor markers
  • 24-hour urine collection for protein, or spot urine for protein/creatinine ratio
Detalhes completos

Treatment algorithm

ACUTE

nonpregnant: no cancer and with an acute medical illness

nonpregnant: with cancer

nonpregnant: undergoing nonorthopedic surgery

nonpregnant: undergoing orthopedic surgery

nonpregnant with major trauma

pregnant

Contributors

Authors

Lara N. Roberts, MBBS, MD (Res), FRCP, FRCPath
Lara N. Roberts

Consultant Haematologist

King's Thrombosis Centre

King's College Hospital

London

UK

Disclosures

LNR has received speaker fees from Bayer and Viatris.

Roopen Arya, BMBCh (Oxon), MA, PhD, FRCP, FRCPath
Roopen Arya

Professor of Thrombosis and Haemostasis

King's Thrombosis Centre

King's College NHS Foundation Trust

London

UK

Disclosures

RA declares that he has no competing interests.

Peer reviewers

Beverly Hunt, FRCP, FRCPath, MD

Professor of Thrombosis & Haemostasis

King's College

Consultant

Departments of Haematology, Pathology & Rheumatology

Lead in Blood Sciences

Guy's & St Thomas' NHS Foundation Trust

London

UK

利益声明

BH declares that she has no competing interests.

Per Morten Sandset, MD, PhD

Senior Consultant and Head of Department

Oslo University Hospital Ullevål

Department of Hematology

Professor in Hematology

University of Oslo

Oslo

Norway

利益声明

PMS declares that he has no competing interests.

Michael Bromberg, MD, PhD

Associate Professor

Director of Hematologic Malignancies

Medicine and Pharmacology

Temple University School of Medicine

Philadelphia

PA

Declarações

MB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e691S-736S.Texto completo  Resumo

American College of Chest Physicians. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST. 2012;141(suppl 2):e1-801.Texto completo

Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58.Texto completo  Resumo

Anderson DR, Morgano GP, Bennett C, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019 Dec 10;3(23):3898-944.Texto completo  Resumo

Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol. 2023 Jun 1;41(16):3063-71.Texto completo  Resumo

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Hypercoagulable state images
  • Diretrizes

    • NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease​​
    • Venous thromboembolism in cancer patients: clinical practice guideline​
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Deep vein thrombosis

    Sickle cell disease

    Mais Folhetos informativos para os pacientes
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