Hereditary coagulopathies: practical diagnosis and management for the plastic surgeon.
BACKGROUND
Venous thromboembolism is a devastating complication representing one of the major causes of postoperative death in plastic surgery. Within the scope of plastic surgery, body-contouring procedures are often considered to carry a higher risk of venous thromboembolism. Hereditary thrombophilias comprise a group of conditions defined by a genetic predisposition to thrombosis development. Collectively, hereditary thrombophilias are present in at least 15 percent of Western populations and underlie approximately half of thromboembolic events. Although the topic of venous thromboembolism is discussed widely throughout the literature, there is little published on the diagnosis and management of hereditary thrombophilias in the plastic surgery literature. The goals of this study were to present a review of the major inherited thrombophilias, to delineate the risk of these disorders, and to recommend a practical algorithm for patient screening and management before major plastic surgery.


METHODS
A MEDLINE search was performed from 1965 to the present to review the literature on inherited thrombophilia disorders.


RESULTS
Based on the English language literature and clinical experience, the authors suggest practical guidelines for screening and management of hereditary thrombophilias. A thorough medical history and preoperative evaluation are key to reducing venous thromboembolism complications.


CONCLUSIONS
Hereditary thrombophilias are present in a significant number of thromboembolic events. Preoperative vigilance on the part of the plastic surgeon may help to identify patients with undiagnosed hereditary thrombophilias and thereby decrease the incidence of venous thromboembolism.
Friedman
Tali
T
Pittsburgh, Pa.; and St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Hematology, University of Pittsburgh Medical Center, and the BodyAesthetic Research Center.
O'Brien Coon
Devin
D
Michaels V
Joseph
J
Bontempo
Franklin
F
Young
V Leroy
VL
Clavijo
Julio A
JA
Rubin
J Peter
JP
D020016:Activated Protein C Resistance / Q000378:metabolism; D000465:Algorithms; D020152:Antithrombin III Deficiency / Q000175:diagnosis; D001779:Blood Coagulation Factors / Q000032:analysis; D005165:Factor V / Q000235:genetics; D006801:Humans; D020138:Hyperhomocysteinemia / Q000175:diagnosis; D009154:Mutation; D020151:Protein C Deficiency / Q000175:diagnosis; D018455:Protein S Deficiency / Q000175:diagnosis; D011516:Prothrombin / Q000235:genetics; D013518:Surgery, Plastic; D013924:Thrombophlebitis / Q000175:diagnosis / Q000235:genetics* / Q000517:prevention & control
D001779:Blood Coagulation Factors; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin