From the Guidelines
A hypercoagulable work-up should include a complete blood count, prothrombin time, and activated partial thromboplastin time, as these are the initial recommended tests for evaluating suspected cerebral venous thrombosis 1. When evaluating a patient for hypercoagulability, it is essential to consider both inherited and acquired thrombophilias. The initial laboratory tests should include:
- Complete blood count
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT) Additional tests to consider include:
- Factor V Leiden mutation
- Prothrombin G20210A mutation
- Protein C activity
- Protein S activity
- Antithrombin III activity
- Lupus anticoagulant
- Anticardiolipin antibodies
- Beta-2 glycoprotein antibodies
- Homocysteine levels
- JAK2 V617F mutation testing It is crucial to note that the timing of testing is important, as acute thrombosis, inflammation, pregnancy, and anticoagulant therapy can affect results 1. Ideally, these tests should be performed at least 2-3 weeks after discontinuation of anticoagulation therapy and when the patient is not experiencing an acute thrombotic event. However, genetic tests like factor V Leiden and prothrombin gene mutation can be performed at any time. The evidence from 1 provides a foundation for the initial work-up, while also considering the comprehensive panel of tests that can help identify both common inherited thrombophilias and acquired conditions that increase clotting risk, allowing for appropriate management strategies to prevent recurrent thrombosis.
From the Research
Hypercoagulable Work-up Labs
The following labs are recommended for a hypercoagulable work-up:
- Prothrombin time (PT) 2, 3
- Activated partial thromboplastin time (APTT) 2, 3
- Fibrinogen (FBG) assay 3
- D-dimer (D-DI) assay 2, 3
- Coagulation inhibitor levels, including:
- Tests for fibrinolysis, including:
- Factor assays, including:
- Von Willebrand factor (vWF) antigen 2
- vWF ristocetin cofactor 2
- A disintegrin and metalloprotease with thrombospondin type 1 motifs 13 antigen 2
- Prothrombin fragment F1+2 2
- Activated factor VII 2
- Clot lysis time 2
- Endogenous thrombin potential (ETP) with and without thrombomodulin 2 Note that not all of these labs may be necessary for every patient, and the specific labs ordered may depend on the individual patient's clinical presentation and medical history 4.