From the Research
For a patient with a suspected hypercoagulable state, I recommend a comprehensive laboratory evaluation including complete blood count with platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels as initial screening tests. This approach is supported by the most recent study 1, which highlights the importance of identifying a hypercoagulable state in patients to prevent thromboembolic events. Further specific testing should 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 Additional tests to consider are:
- Homocysteine levels
- Factor VIII levels
- JAK2 V617F mutation testing if myeloproliferative disorders are suspected
- Testing for paroxysmal nocturnal hemoglobinuria and flow cytometry may be warranted in certain cases It's essential to time these tests appropriately, as acute thrombosis, pregnancy, liver disease, and certain medications can affect results, as noted in 2 and 3. Ideally, testing for protein C, protein S, and antithrombin should be done at least 2-3 weeks after completing anticoagulation therapy, as suggested in 4. These tests help identify inherited or acquired conditions that increase clotting risk, allowing for appropriate management strategies to prevent future thrombotic events. The use of rotational thromboelastometry (ROTEM) may also be helpful in assessing the patient's coagulation profile, as demonstrated in 1.