Two Onc Docs Thrombophilias
Nov 6, 2023
This podcast discusses testable thrombophilia syndromes including Antiphospholipid Syndrome, Antithrombin III deficiency, Protein C and S deficiency, Factor V Leiden, and Prothrombin mutations. They cover the presentation, diagnostic testing, and treatment, as well as the impact of medications on protein levels. Additionally, they explore the use of unfractionated heparin during C-sections, combination therapy for women with anti-phospholipid syndrome, and the timing of anticoagulation after delivery.
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APS Requires Clinical And Persistent Lab Criteria
- APS diagnostic criteria combine clinical events (thrombosis or defined pregnancy losses) with persistent high-titer antiphospholipid antibodies.
- Lupus anticoagulant confers higher thrombosis risk than anticardiolipin antibodies.
How To Test For Antithrombin III Deficiency
- Delay antithrombin III testing until ≥3 weeks after acute VTE and recheck low values to confirm deficiency.
- Remember unfractionated heparin lowers antithrombin III and DOACs falsely elevate activity.
Protein C Testing And Warfarin Bridge
- For protein C testing, measure both antigen and activity and consider deficiency when activity is <20%.
- Stop warfarin for ≥3 weeks and bridge with heparin when initiating warfarin to avoid worsening thrombosis.