Hypercoagulation

Coumarin is also widely used for long-term anticoagulation in chronic atrial fibrillation (particularly to avoid cardioembolic strokes), to prevent DVT or PE in patients with chronic hypercoagulability (e.g., congenital AT or protein C deficiency), or to prevent... 

The most common adverse reaction associated with the administration of fat emulsion is sepsis caused by administration equipment and thrombophlebitis caused by vein irritations from concurrently administering hypertonic solutions. Less frequently occurring adverse reactions include dyspnea, cyanosis, hyperlipidemia, hypercoagulability, nausea, vomiting, headache flushing, increase in temperature sweating, sleepiness, chest and back pain, slight pressure over the eyes, and dizziness. 

This category includes patients with rare causes of strokes such as nonatherosclero-tic vasculopathies, cerebral venous thrombosis, hypercoagulable states, or hematologic disorders. Two such disorders are discussed below. 

Patients with HF are at an increased risk of thromboembolic events secondary to a combination of hypercoagulability, relative stasis of blood, and endothelial dysfunction. However, the role of antiplatelets and anticoagulants remains debatable due to a lack of prospective clinical trials. 

The risk of venous thromboembolism (VTE) is related to several easily identifiable factors including age, prior history of VTE, major surgery (particularly orthopedic procedures of the lower extremities), trauma, malignancy, pregnancy, estrogen use, and hypercoagulable states. These risks are additive. 

Venous thromboembolism (VTE) is one of the most common cardiovascular disorders in the United States. VTE is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE) resulting from thrombus formation in the venous circulation (Fig. 7-1).1 It is often provoked by prolonged immobility and vascular injury and is most frequently seen in patients who have been hospitalized for a serious medical illness, trauma, or major surgery. VTE can also occur with little or no provocation in patients who have an underlying hypercoagulable disorder. 

First episode of idiopathic VTE with or without a documented hypercoagulable abnormality Warfarin 12 Continue warfarin therapy after 12 months if patient is at low risk for bleeding... 

Tests for hypercoagulable states, such as protein C deficiency and antiphospholipid antibody, should be done only when the cause of stroke cannot be determined based on the presence of well-known risk factors for stroke. 

Insulin resistance has been associated with a number of other cardiovascular risks, including abdominal obesity, hypertension, dyslipidemia, hypercoagulation, and hyperinsulinemia. The clustering of these risk factors has been termed metabolic syndrome. It is estimated that 50% of the United States population older than 60 years of age have metabolic syndrome. The most widely used criteria to define metabolic syndrome were established by the National Cholesterol Education Program Adult Treatment Panel III Guidelines (summarized in Table 40-2). 

Hypercoagulable state A disorder or state of excessive or frequent thrombus formation also known as thrombophilia. 

IL-1 (17.5) Monocyte/macrophage, lymphocyte, neutrophil, endothelium, fibroblast keratinocyte Activation of T cells, B cells, natural killer cells, osteoblasts, and endothelium. Induces fever, sleep, anorexia, ACTH release, hepatic acute phase protein synthesis and HSPs. Leads to myocardial depression, hypercoagulability, hypotension/sbock, and death. Simulates production of TNF, IL-6, and IL-8 and stress hormone release. Suppression of cytochrome P-450, thyro-globulin, and lipoprotein synthesis. Procoagulant activity. Antiviral activity. 

Laboratory tests for hypercoagulable states should be done only when the cause of the stroke cannot be determined based on the presence of well-known risk factors. Protein C, protein S, and antithrombin III are best measured in steady state rather than in the acute stage. Antiphospholipid antibodies are of higher yield but should be reserved for patients aged less than 50 years and those who have had multiple venous or arterial thrombotic events or livedo reticularis. 

Hypercoagulable states include malignancy activated protein C resistance deficiency of protein C, protein S, or antithrombin factor VIII or XI excess antiphospholipid antibodies and other situations. Estrogens and selective estrogen receptor modulators have been linked to venous thrombosis, perhaps due in part to increased serum clotting factor concentrations. Although a thrombus can form in any part of the venous circulation, the majority of thrombi begin in the lower extremities. Once formed, a venous... 

Assessment of the patient s status should focus on the search for risk factors (e.g., increased age, major surgery, previous VTE, trauma, malignancy, hypercoagulable states, and drug therapy). Signs and symptoms of DVT are nonspecific, and objective tests are required to confirm or exclude the diagnosis. 

Major surgery, age >40 years, and prior history of VTE Major surgery, age >40 years, and malignancy Major surgery, age >40 years, and hypercoagulable state Spinal cord injury or stroke with limb paralysis... 

Estrogens have a dose-related effect in the development of venous thromboembolism (VTE) and pulmonary embolism. This is especially true in women with underlying hypercoagulable states or who have acquired conditions (e.g., obesity, pregnancy, immobility, trauma, surgery, and certain malignancies.)... 

Risk factors for venous thromboembolism in pregnancy include increasing age, history of thromboembolism, hypercoagulable conditions, operative vaginal delivery or cesarean section, obesity, and a family history of thrombosis. 

Hypercoagulable states, in turn, have been traditionally associated with venous thrombosis. Consequently, attention has been paid to alterations of the hemostatic balance. Although this is a systemic variable, focality is favored due to the contribution of decreased blood flow, as confirmed by the preferential development of venous thrombi at the level of valves, an area of stasis where low-velocity flow is moderately turbulent. 

There is discussion on the adequacy of tests to identify the hypercoagulable states underlying susceptibility to VTED. The complexity of factors and interactions involved in the hemostatic equilibrium has favored the use of functional tests. Among the several options available the measurement of fragments 1 + 2 (F1 + 2), the amino terminus fragment split during the activation of prothrombin has been widely considered the test of choice. The sparse information available for SERMs, however, is unclear. Raloxifene did not modify... 

The prevention of excessive blood loss through breaches of the vascular barrier is important to maintain oxygen delivery and blood volume. A fall in blood volume would cause a drop in blood pressure and the metabolism of all of the major organs would be badly affected. Failures of the haemostatic mechanisms can lead to haemorrhage (bleeding disorders) or thrombosis (hypercoagulation disorders). 

Hypercoagulability, blood, 330 Hyperkinetic children, 88 Hyperthyroidism, 240 Hypoglycemia, 136 Hypothyroidism, 95... 

Hypercoagulability Some studies have shown that women taking estrogen replacement therapy have hypercoagulability, primarily related to decreased antithrombin activity. This effect appears dose- and duration-dependent and is less pronounced than that associated with OC use. 

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