Two Onc Docs Thrombophilias
Nov 6, 2023
This podcast discusses testable thrombophilia syndromes including Antiphospholipid Syndrome, Antithrombin III deficiency, Protein C and S deficiency, Factor V Leiden, and Prothrombin mutations. They cover the presentation, diagnostic testing, and treatment, as well as the impact of medications on protein levels. Additionally, they explore the use of unfractionated heparin during C-sections, combination therapy for women with anti-phospholipid syndrome, and the timing of anticoagulation after delivery.
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Test Only When It Changes Management
- Do only order thrombophilia tests if the results will change management and avoid testing while patients are anticoagulated.
- Repeat abnormal tests weeks later because acute clotting and anticoagulants distort results.
Lab Interference Alters Thrombophilia Results
- Protein C, protein S, and antithrombin III give the highest thrombosis risk among hereditary deficiencies.
- DOACs, warfarin, heparin and acute thrombosis all distort these lab levels in different ways.
Diagnose And Treat Antiphospholipid Syndrome
- Check antiphospholipid antibodies (DRVVT, lupus anticoagulant, anticardiolipin, anti-β2GPI) before anticoagulation and repeat at ≥12 weeks.
- Treat confirmed antiphospholipid syndrome with warfarin (INR 2–3) and avoid DOACs.