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The Hypercoagulable States

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Grant support: By grant HL-27465 from the National Institutes of Health; a Grant-in-Aid from the American Heart Association with funds contributed in part by the Massachusetts Affiliate; and the William F. Milton Fund. Dr. Schafer is an Established Investigator of the American Heart Association.

▸Requests for reprints should be addressed to Andrew I. Schafer, M.D.; Hematology Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street; Boston, MA 02115.

Boston, Massachusetts

© 1985 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1985;102(6):814-828. doi:10.7326/0003-4819-102-6-814
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Patients are considered to have hypercoagulable states if they have laboratory abnormalities or clinical conditions that are associated with an increased risk of thrombosis (prethrombotic states) or if they have recurrent thrombosis without recognizable predisposing factors (thrombosis-prone). The number of specific primary hypercoagulable states that are recognized is growing. These disorders are generally inherited abnormalities of coagulation in which a physiologic anticoagulant mechanism is defective: for example, antithrombin III deficiency, protein C and protein S deficiency, abnormalities of the fibrinolytic system, and dysfibrinogenemias. Secondary hypercoagulable states are generally acquired disorders in patients with underlying systemic diseases or clinical conditions known to be associated with an increased risk of thrombosis: for example, malignancy, pregnancy, use of oral contraceptives, myeloproliferative disorders, hyperlipidemia, diabetes mellitus, and abnormalities of blood vessels and rheology. The complex pathophysiologic features of these secondary hypercoagulable states are discussed, and a framework is provided for the laboratory investigation and systematic clinical approach to the patient.







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