What labs are used to diagnose hypercoagulability?

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Last updated: February 17, 2025 • View editorial policy

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From the Guidelines

Hypercoagulation labs typically include a comprehensive panel to evaluate the coagulation cascade, comprising tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer levels 1. Additional tests may include:

  • Factor assays (e.g., factor VIII, factor IX)
  • Antithrombin III
  • Protein C
  • Protein S levels These tests are used to identify patients at risk of thrombotic events, although no single laboratory assay can identify all known thrombophilic disorders 1. In cases of suspected hypercoagulability, thrombin generation (TG) assays may also be used to investigate the contribution of natural pro- and anticoagulants, or to study the impact of drugs on hemostasis 1. However, standardization of TG assays is still an issue, and efforts are being made to harmonize methods and reduce interlaboratory variation 1. It is essential to note that the choice of labs may vary depending on the individual patient's risk factors and clinical presentation, and treatment decisions should be made on a case-by-case basis 1.

From the Research

Coagulation Assays for Hypercoagulability

The following coagulation assays are used to diagnose hypercoagulability:

  • Prothrombin time (PT) 2
  • Activated partial thromboplastin time (aPTT) 2, 3, 4, 5
  • Fibrinogen assay 2, 4, 5
  • D-dimer concentrations 4, 5
  • Thromboelastography (TEG) 6, 4
  • Thrombodynamics (TD) 4
  • Global coagulation assays, such as calibrated automated thrombogram and overall haemostatic potential assay 6

Laboratory Tests for Hypercoagulability

Laboratory tests used to diagnose hypercoagulability include:

  • Mixing study to assess an abnormally prolonged PT or aPTT 2
  • Factor activity assays to measure the activity of specific coagulation factors 2
  • Testing for factor inhibitors, such as lupus anticoagulant 2, 3
  • Testing for antiphospholipid antibodies 2
  • Measurement of von Willebrand factor (VWF) protein and activity 2

Analyzers Used for Coagulation Assays

Different analyzers can be used to perform coagulation assays, including:

  • Roche Cobas t711 analyzer 5
  • Werfen ACL Top 750 analyzer 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Coagulation Testing in the Core Laboratory.

Laboratory medicine, 2017

5
Research

Assessment of coagulation assays on Roche Cobas t711 analyzer: performance and clinical implications.

Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2023

6
Research

Global coagulation assays in hypercoagulable states.

Journal of thrombosis and thrombolysis, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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