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The Hypercoagulable State: New Developments in Thrombosis and Anticoagulation

Differential Diagnosis of the Patient Presenting with Thrombosis or a Thrombotic Diathesis

Inherited (Primary) Hypercoagulable States

Acquired (Secondary) Hypercoagulable States

In association with physiologic or thrombogenic stimuli post-operative state, pregnancy and post-partum, estrogen use, immobilization, trauma, aging, lupus anticoagulant or antiphospholipid syndrome

In association with other clinical disorders

neoplasia, myeloproliferative disorders, PNH, cancer chemotherapy, nephrotic syndrome, heparin-induced thrombocytopenia

Hyperhomocysteinemia

Inherited Thrombotic Disorders

Activated Protein C Resistance (Factor V Leiden)

Prothrombin Gene Mutation (G -~ A transition at position 20210 in the 3'-

untranslated region)

Antithrombin III Deficiency

Protein C Deficiency

Protein S Deficiency

Dysfibrinogenemia (rare)

Sites of Thrombosis According to Coagulation Defect

Abnormality Arterial Venous

Factor V Leiden - +

Antithrombin Ill deficiency - +

Protein C deficiency - +

Protein S deficiency - +

Hyperhomocysteinemia + +

Lupus Anticoagulant