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Hypercoagulable States

Inherited hypercoagulable states
  1. Defective inhibition of coagulation factors
    1. ↑ factor V Leiden C (resistant to inhibition by activated protein C)
    2. Protein C deficiency & protein S deficiency
  2. Impair clot lysis
    1. dysfibrinogenemia
    2. Plasminogen deficiency
    3. TPA deficiency
    4.  PAI - I
  3. Idiopathic
  4. Homocystinuria

Extra Edge:


Factor V Leiden deficiency. Clot factor deficiency will cause bleeding so its not a hypercoagulable condition

Factor V Leiden

  1. Factor V Leiden thrombophilia is a genetically inherited disorder of blood clotting.
  2. Factor V Leiden is a variant (mutated form) of human factor V that causes an increase in blood clotting (hypercoagulability).
  3. In this disorder, the Leiden variant (form) of factor V cannot be inactivated by activated protein C, and so clotting is encouraged.
  4. Factor V Leiden is the most common hereditary hypercoagulability.

Antiphospholipid syndrome (Hypercoagulability)
  1. anti cardiolipin ab
  2. Anti β-2 glycoprotein 1 ab
  3. Lupus anticoagulant
  4. Thrombocytopenia
  5. Hemolytic A
  6. Recurrent abortion
  7. Pregnancy Induce Hypertension
  8. Thrombotic effects in Artery & Vain
  9. PTT
  10. False +ve VDRL
Other’s causes of False +ve VDRL
  1. Recent viral infection
  2. Immunization
  3. Genital herpes HIV
  4. Malaria
  5. Parental drugs use
  6. old Age
  7. Rheumatoid arthritis
Table - Risk Factors for Venous Thrombosis (Ref. Hari. 18th ed., Pg - 987, Table, 117.3)
Acquired Inherited
Major surgery Antithrombin deficiency
Major trauma Protein C deficiency
PNH Protein S deficiency
Malignancy Factor V Leiden (FVL)
Antiphospholipid syndrome Prothrombin
Puerperium, Pregnancy Dysfibrinogenemia
Prolonged bed rest  
Plaster cast  
Hormonal replacement therapy  
Myeloproliferative disorders  
Long-haul travel  
Old Age  
Fibrinolytic drugs
Mechanism of Action (Ref. Hari. 18th ed., Pg - 981, Fig, 118.3)
Fig: The fibrinolytic system and its regulation. Plasminogen activators convert plasminogen to plasmin. Plasmin then degrades fibrin into soluble fibrin degradation products. The system is regulated at two levels. Type 1 plasminogen activator inhibitor (PAI-1) regulates the plasminogen activators, whereas α2-antiplasmin serves as the major inhibitor of plasmin.
The plasminogen – Plasmin System
Examples of fibrinolytic agents:- Streptokinase; acylated plasminogen streptokinase activator complex (anistreplase); urokinase; recombinant tissue-type plasminogen activator (rt-PA), which is also known as alteplase or Activase; and two recombinant derivatives of rt-PA, tenecteplase and reteplase.
New Fibrinolytic Agents
Desmoteplase, Alfimeprase,

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