title: Thrombosis, Hypercoagulable States, and Anticoagulants.
abstract: Patients with derangements of secondary hemostasis resulting from inherited or acquired thrombophilias are at increased risk of venous thromboemboli (VTE). Evaluation of a patient with suspected VTE proceeds via evidence-based algorithms that involve computing a pretest probability based on the history and physical examination; this guides subsequent work-up, which can include D dimer and/or imaging. Testing for hypercoagulable disorders should be pursued only in patients with VTE with an increased risk for an underlying thrombophilia. Direct oral anticoagulants are first-line VTE therapies, but they should be avoided in patients who are pregnant, have active cancer, antiphospholipid antibody syndrome, severe renal insufficiency, or prosthetic heart valves.
authors.affiliation: Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Marie A
authors.initials: MA
authors.lastname: Hollenhorst
authors.affiliation: Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address: ebattinelli@partners.org.
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Battinelli
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000188:drug therapy*; D000075202:Contraindications; D003952:Diagnostic Imaging; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006403:Hematologic Tests; D006801:Humans; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Anticoagulation; Deep venous thrombosis; Pulmonary embolism; Thrombophilia; Venous thromboembolism