Core IM | Internal Medicine Podcast
#173 Hypercoagulability Workup: 5 Pearls Segment
Mar 19, 2025
Dr. Rebecca Carpley, a hematologist at Massachusetts General Hospital, dives into the complexities of hypercoagulability and the nuances of clot management. She discusses reframing clots by reversibility, shedding light on how Virchow's triad categorizes clot etiology. Dr. Carpley addresses inherited protein deficiencies, emphasizing factors influencing testing. The conversation also examines the reliability of genetic tests like Factor V Leiden, considering the critical role of family history in assessing thrombosis risks. Insights into individualized care for women of childbearing age add depth to this engaging discussion.
44:49
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Quick takeaways
- The concept of reversibility shifts the classification of clots to emphasize temporary versus permanent risk factors affecting treatment decisions.
- Virchow's triad aids in understanding the underlying causes of thrombosis, enhancing the differential diagnosis of venous thromboembolism.
Deep dives
Understanding Provoked vs. Unprovoked Clots
Clots are categorized into provoked and unprovoked types, each with unique management considerations. A provoked clot occurs when there is a clear, identifiable risk factor, while an unprovoked clot arises unexpectedly without any known triggers. The risk of recurrence for unprovoked clots can be significant, leading to a recommendation for long-term anticoagulation therapy. This distinction is crucial in clinical practice, as it helps guide treatment strategies, particularly when determining the need for ongoing anticoagulation.
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