From the Guidelines
A hypercoagulability panel should be ordered for patients presenting with acute limb ischemia, particularly those with atypical presentations, to evaluate for underlying hypercoagulable conditions, as recommended by the American College of Radiology 1. The panel typically includes tests for Factor V Leiden mutation, Prothrombin G20210A mutation, Protein C and S deficiencies, Antithrombin III deficiency, Lupus anticoagulant, Anticardiolipin antibodies, and anti-thrombin III, as well as prothrombin time, partial thromboplastin time, and platelet count 1. Some key points to consider when ordering a hypercoagulability panel include:
- Testing is recommended for patients with unexplained venous thromboembolism (VTE), thrombosis at unusual sites, recurrent thrombosis, family history of thrombophilia, thrombosis at a young age, or pregnancy complications potentially related to clotting disorders.
- The panel should be ordered at least 2-3 months after an acute thrombotic event and preferably when the patient is not on anticoagulation therapy, as acute thrombosis and anticoagulants can affect test results.
- Results from this panel help guide treatment decisions, including the duration of anticoagulation therapy and prophylaxis strategies for high-risk situations. It is also important to note that the likelihood of stroke from most prothrombotic states seems to be relatively low, but the stroke risk increases when a prothrombotic disorder occurs in children with other risk factors, as reported by the American Heart Association 1. However, the most recent and highest quality study, as per the American College of Radiology 1, takes precedence in guiding clinical decision-making for hypercoagulability panels in the context of acute limb ischemia.
From the Research
Hypercoagulable Panel
The hypercoagulable panel is a series of tests used to diagnose conditions that increase the risk of blood clots.
- The panel typically includes tests for:
- Factor V Leiden
- Prothrombin G20210A gene mutation
- Antithrombin deficiency
- Protein C deficiency
- Protein S deficiency
- Antiphospholipid antibodies
- Homocysteine levels
Conditions Associated with Hypercoagulability
Several conditions are associated with hypercoagulability, including:
- Cancer-associated thrombosis (CAT) 2
- Antiphospholipid syndrome (APS) 2, 3
- Hereditary thrombophilia 2, 4
- Factor V Leiden 5, 6
- Prothrombin G20210A gene mutation 3, 5
Diagnosis and Management
Diagnosis of hypercoagulable conditions typically involves a combination of clinical evaluation and laboratory testing.
- The use of direct oral anticoagulants (DOACs) may be effective in treating certain hypercoagulable conditions, such as CAT 2
- However, the use of DOACs in patients with APS and hereditary thrombophilia should be avoided due to limited data and potential for worse outcomes 2
- Management of patients with hereditary hypercoagulable disorders may involve avoiding additional risk factors for thrombosis and using more aggressive primary prophylaxis when necessary 4