From the Guidelines
The correct answer is C. family history. This patient should be counseled that screening for a hypercoagulability condition is recommended due to her family history of thrombotic events. The patient's mother and aunt both have a history of deep vein thrombosis and pulmonary embolism, which suggests a possible hereditary thrombophilia. When multiple first-degree relatives have experienced thrombotic events, especially at relatively young ages (mid-40s), this significantly increases the likelihood of an underlying genetic hypercoagulable disorder such as Factor V Leiden, Protein C or S deficiency, or antithrombin deficiency, as suggested by the American College of Medical Genetics consensus statement on factor V Leiden mutation testing 1.
Key points to consider in this patient's case include:
- Her desire for pregnancy, as pregnancy itself is a hypercoagulable state that increases thrombosis risk
- Her current use of oral contraceptives, which is an acquired risk factor that compounds any underlying genetic predisposition to clotting
- Her smoking history, which also increases the risk of thrombotic events, particularly in young female smokers, as noted in the guidelines 1
- The importance of identifying a hypercoagulable condition before pregnancy to allow for appropriate prophylactic measures during pregnancy and the postpartum period, when thrombosis risk is highest.
Given these considerations, screening for a hypercoagulability condition is crucial for this patient, primarily due to her family history of thrombotic events, and the potential for an underlying genetic disorder that could significantly impact her health and the health of her future pregnancy.
From the Research
Hypercoagulability Condition Screening
The patient should be counseled that screening for a hypercoagulability condition is recommended due to her:
- Family history of deep vein thrombosis and pulmonary embolism, as stated in the patient's history 2, 3, 4, 5 Specifically, the patient's family history of thrombotic disorders, including her mother and aunt having a history of deep vein thrombosis and pulmonary embolism, suggests a possible inherited thrombophilia, such as factor V Leiden or the prothrombin gene mutation 2, 3, 4, 5.
Relevant Factors
The following factors are relevant to the patient's condition:
- Family history: The patient's family history of thrombotic disorders is a significant risk factor for hypercoagulability 2, 3, 4, 5
- Desire to be pregnant: Pregnancy is a hypercoagulable state, and women with a history of thrombophilia are at increased risk for venous thromboembolism during pregnancy 2, 3, 6
- Other factors: While the patient's cigarette use, marijuana use, and oral contraceptive use may contribute to her overall health risks, they are not directly related to the recommendation for screening for a hypercoagulability condition 2, 3, 4, 5, 6
Screening Recommendations
Based on the patient's family history and desire to be pregnant, screening for a hypercoagulability condition is recommended to assess her risk for venous thromboembolism and to guide management during pregnancy 2, 3, 4, 5, 6.