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Hypercoagulable StateHypercoagulable States: Causes, Symptoms, Risk Factors, Medications and Treatments

Commonly asked questions about hypercoagulable states:

What Is A Hypercoagulable State?

A hypercoagulable state (HS) is a medical term for a condition that gives one an increased chance of developing a blood clot. There are various forms of HS, and each has a different cause. However, they are all able to increase the chances of someone developing a clot.

Normal coagulation is important during an injury, because it helps stop the bleeding and starts the healing process. However, if the blood clots more than usual when just moving through the body it is then referred to as a HS or thrombophilia.

What Types of Hypercoagulable States Are There?

There are various forms of hypercoagulable states, according to the Cleveland Clinic. HS can either be inherited or acquired later in life. Inherited HS comes from a child’s parents; a child receives one gene from each parent.

If one of the genes that a child receives is mutated they have a heterozygous mutation. If both copies of genes that a child receives from their parents are mutated it is a homozygous mutation.

A person with a homozygous mutation (2 mutated genes) is at a higher risk of developing a blood clot than someone with a heterozygous mutation (one mutated gene). The following is a list of the most common forms of inherited and acquired HS.

Common types of inherited HS include:

  • Factor V Leiden: This is the most common form of HS. It is a mutation of one of the clotting factors in the blood called factor V. This mutation increases your chances of developing an abnormal blood clot.
  • Prothrombin gene mutation (factor II): A blood clotting protein that is needed to form fibrin. If someone has too little Factor II they may bleed too much. If someone has more than they should, irregular blood clots are more likely to form.
  • Deficiencies of natural proteins: When your body is lacking natural proteins that prevent clotting (such as antithrombin, protein C and protein S) your blood becomes more susceptible to irregular clotting.
  • Elevated levels of homocysteine: A form of amino acid, which are the building blocks of proteins. When the proteins break down there may be elevated levels of amino acids, such as homocysteine, which has been linked to atherosclerosis and blood clots.
  • Elevated or dysfunctional fibrinogen (factor I): If your body does not produce enough fibrinogen or your fibrinogen is dysfunctional, clots will have a tough time forming, which can lead to excessive bleeding.

Common types of acquired HS include:

  • Cancer
  • Some medications that are used to treat cancer (tamoxifen, bevacizumab, thalidomide and lenalidomide)
  • Recent trauma or surgery
  • Obesity
  • Pregnancy
  • Supplemental estrogen use, including birth control pills
  • Hormone replacement therapy
  • Prolonged immobility (sitting, bed rest)
  • Heart attack
  • Inflammatory bowel syndrome
  • HIV/AIDS

What Risk Factors Are Associated With Hypercoagulable States?

According to The National Blood Clot Alliance and Medscape, the factors that are attributed to developing a hypercoagulable state depend on whether or not you have a inherited or acquired form of HS.

Inherited Risk Factors

Since we all inherit two copies of each gene, one from each of our parents, there are a few things to take into account when predicting the risk of passing the mutation along to a child. If you have a heterozygous mutation the chances of passing the mutation along to your child are 50%.

However, if you have a homozygous mutation, there is a 100% chance of passing that gene along to your child. The gene copy that your child will inherit is completely random and there is nothing that can be done to alter this chance.

A person is also at a higher risk of developing a blood clot if they have one or more of the inherited mutations, such as having both factor V and an excess of factor II.

Acquired Risk Factors

  • Advanced age
  • Prolonged immobility (sitting, bed rest)
  • Pregnancy
  • Oral contraception use
  • Obesity
  • Diabetes
  • Hormone replacement therapy
  • Cancer

What Signs/Symptoms Are Associated With Hypercoagulable States?

It is near impossible to tell if someone suffers from HS by just looking at them. The National Blood Clot Alliance states that the major sign/symptom that you may have a hypercoagulable state would be an increased or decreased clotting factor. When you have a decreased clotting factor the major sign that you have to look out for is hemorrhaging (excessive bleeding). For example, if you notice that it takes an abnormally long time to stop bleeding after small cuts and scrapes you may want to get tested for HS.

Having an increased clotting factor can result in thrombosis (irregular clotting). An example of this would be potential blood clots. There are different signs to look for depending on where the blood clot is located. A deep vein thrombosis clot may involve the following:

  • Swelling in one arm or leg
  • Leg pain or tenderness similar to a cramp
  • Slight red or blue discoloration of the skin
  • Leg or arm is warm to the touch

A pulmonary embolism clot may involve symptoms such as:

  • Sudden shortness of breath
  • Chest pain such as a sharp stabbing feeling
  • Rapid heart rate
  • Unexplained cough, sometimes accompanied by bloody mucus

What Medications/Treatments Are Used To Combat Hypercoagulable States?

According to Riley Children’s Health at Indiana University the treatment for a hypercoagulable state depends on whether or not it is a hemorrhage- or thrombosis-related condition. Treatment for a hemorrhaging state may include:

  • Rest, ice, compression and elevation: These simple steps can help stop a bleed as well as reduce the swelling and pain.
  • Replacement therapy: Infusions of concentrated clotting factor can help stop a bleeding that is in progress, but it can also be used to on a regular basis to prevent bleeding in the first place.
  • Desmopressin: A man-made hormone similar to the naturally occurring hormone vasopressin. Desmopressin is used to stimulate the body to product more of clotting factor VIII, which helps to control the bleeding.
  • Discontinuing The use of NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are mild blood thinners that reduce the blood’s ability to clot. They include drugs such as aspirin and ibuprofen.
  • Surgery: When blood accumulates in a joint from hemorrhage, surgery can be used to relieve the swelling.
  • Blood transfusions: If you have a low platelet count or platelets that are not functioning properly, a platelet transfusion can replace them. Platelets are the proteins in your blood that help it to clot.
  • Joint strengthening: Participating and regular activity and exercise can keep your joints strong and help prevent bleeds.

Treatment for a thrombosis related state may include:

  • Heparin or low molecular weight heparin: Are both fast-acting and effective blood thinners that are used to help treat excessive clotting. However, they have the possibility to cause hemorrhaging. When using these drugs you must be closely monitored to prevent bleeding.
  • Warfarin (coumadin): A very effective blood thinner, but it reacts with a number of medications and diets so it is used on a case-by-case basis. Coumadin is generally used for long-term treatment, but must also be monitored by getting your blood tested every few weeks.

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View Sources

  1. Cleveland Clinic – Hypercoagulable States
  2. The National Blood Clot Alliance – The Genetics of Thrombophilia
  3. Medscape – Hereditary and Acquired Hypercoagulability
  4. The National Blood Clot Alliance – Hypercoagulability Signs and Symptoms
  5. Riley Indiana University Health – Coagulation Disorders

Resources

Spronk H, Jong M, Verheule S, De Boer H, Maass A, Lau D, Rienstra M, Hunnik A, Kuiper M, Lumeij S, Zeemering S, Linz D, Kamphuisen P, Cate H, Crijns H, Can Gelder I, Van Zonneveld A, Schotten U, Hypercoagulability causes atrial fibrosis and promoted atrial fibrillation, 2016, European Heart Journal, 38(1):38-50 Goldstein D, Uehlinger J, Szymanski J, Mohandas K, Walsh R, Marks E, Himchak E, Gupta R, Wu D, Use of Four-Factor Prothrombin Concentrate Complex in LVAD Recipients Undergoing Transplantation: Impact on Blood Loss, Blood Use, Blood Bank Costs and Clinical Outcomes, 2016, JHltonline, Volume 35(4) S112-S113