Editing Thrombosis (section)

=== ACQUIRED thrombophilia ===

** Anti-phospholipid antibodies (lupus anticoagulant, anti-cardiolipin antibody and anti-B2 glycoprotein I antibody)
*** Test if VTE is unprovoked or in an unusual site
*** Patient has a concomitant autoimmune disorder, previous arterial thromboses including CVA/MI, or a history of recurrent pregnancy failure or fetal death
*** Testing for lupus anticoagulant can be affected by DOAC (false positive)
** Underlying myeloproliferative disease
*** Suspect with splanchnic vein thromboses or VTE in another unusual site
*** Can be present despite normal blood counts
*** Test is JAK2 kinase
*** Consider CALR mutation testing and a BM biopsy if JAK2 is negative in patients with a high index of suspicion
** Consideration of malignancy
*** 10% of those with unprovoked VTE will be diagnosed with cancer in the first year
*** Medical history
*** Examination
*** FBE, calcium, LFts
*** CXR
*** Mammogram
*** Pap smear
*** PSA
*** NBCSP
*** Routine CT and tumour markers is not recommended, according to the Austin guidelines, but can be done depending on risk and clinical scenario
** Hyperhomocysteinaemia - testing not recommended routinely