Core IM | Internal Medicine Podcast #173 Hypercoagulability Workup: 5 Pearls Segment
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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.
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Reframing Clot Categories
- Reframe the "provoked vs. unprovoked" dichotomy to "reversible vs. irreversible."
- Consider if a risk factor is temporary or will persist, as this impacts treatment duration.
Irreversible Risk Factors
- Irreversible risk factors, even with provoked clots, may require long-term anticoagulation, similar to unprovoked clots.
- Examples include obesity, permanent immobility, and some cancers.
Virchow's Triad
- Virchow's triad (stasis, endothelial injury, hypercoagulability) helps understand clot formation mechanisms.
- Stasis includes immobility, heart failure, and hyperviscosity; endothelial injury includes atherosclerosis, infections, radiation; and hypercoagulability includes inherited thrombophilias, cirrhosis, and nephrotic syndrome.