Coagulation - Wikipedia Fibrinogen Thrombophlebitis
Individuals Suitable for Testing. Test Selection - Figure, Fibrinogen Thrombophlebitis. Test Interpretation - Table 4 - Table 5 - Table 6, Fibrinogen Thrombophlebitis.
Almost 2 million Americans succumb annually to a thromboembolic event, 1 with venous thrombosis the third most common cardiovascular disease after ischemic heart disease and stroke. Venous thrombosis affects 1 to Lioton 1000 mit Krampfadern in individuals every year and is associated with life-threatening conditions such as pulmonary embolism PE.
Conditions associated with an increased risk of venous thrombosis can be either inherited or acquired Tables 1 and 2, Fibrinogen Thrombophlebitis. Deficiency of antithrombin, protein C, and protein S may also be acquired. Individuals at high risk for venous thrombosis include those with a personal or family history of thrombosis, inherited coagulation disorders, Haushalte Seife mit Krampfadern, paroxysmal nocturnal hemoglobinuria, essential thrombocythemia, polycythemia vera, recurrent spontaneous abortion and stillbirth, and malignancy.
Additional risk factors include surgery, trauma, physical inactivity bed confinement or paralysiswarfarin induced skin necrosis, diabetes, hyperlipidemia, vasculitis, thrombocytopenia, sepsis, congestive heart failure, Fibrinogen Thrombophlebitis, and use of purified prothrombin complex concentrates.
Other factors that may be associated with increased thrombotic risk include plasminogen deficiency and elevations of plasminogen activator inhibitor-1, lipoprotein Fibrinogen ThrombophlebitisD-dimer, and thrombin-activatable fibrinolysis inhibitor. The risk Fibrinogen Thrombophlebitis thrombosis increases with the number of defects or risk factors present; ie, individuals with multiple conditions associated with thrombosis are at greater risk than those with only one condition.
The identification of thrombotic risk factors and diagnosis of thrombophilia contributes to patient management in multiple ways Table 3.
Such diagnosis is based on personal and family history of thrombosis especially during adolescence and young adult yearsclinical manifestations, Fibrinogen Thrombophlebitis, and laboratory testing. Clear guidelines how to best manage individuals with a family or personal history of documented risk factors and who have not experienced a thrombotic episode have not been established.
Prophylactic treatment is provided to diagnosed patients when in high-risk situations, eg, surgery, Fibrinogen Thrombophlebitis, prolonged immobilization, and pregnancy and puerperium.
Lifelong prophylactic therapy may be considered for those with recurrent thrombotic episodes, high-risk disorders, Fibrinogen Thrombophlebitis with multiple-risk factors and may include aufgrund dessen, was die Beine Krampfadern an transfusions eg, antithrombin concentratesoral anticoagulants, low dose aspirin, and heparin.
Individuals with hyperhomocysteinemia may be treated with vitamin supplementation folic acid, cobalamin, pyridoxine. Individuals Suitable for Testing [ return to contents ] Symptomatic individuals. High-risk individuals predisposed by surgery, trauma, Fibrinogen Thrombophlebitis, immobility, pregnancy, oral contraceptives, Fibrinogen Thrombophlebitis, etc.
Test Availability [ return to contents ] Tests available to assist in diagnosis and management of thrombophilia disorders are listed in Appendix 2.
Additionally, Quest Diagnostics offers panels that include multiple tests, thereby simplifying the test ordering process. Refer to the Quest Diagnostics Directory of Services for information on these panels, which are typically named according to the medical condition.
Test Selection [ return to contents ] Diagnosis. A venous thrombosis laboratory work-up for high-risk or symptomatic individuals begins with a personal and family history.
For example, venous thrombosis in a pediatric patient suggests the likelihood of an inherited disorder; in an individual with SLE, antiphospholipid syndrome should be considered; and in an older individual, malignancy. Testing for multiple etiologies is recommended since venous thrombosis is a polyfactorial disorder, and presence of multiple etiologies increases the risk for thrombosis.
Likewise, if a first thrombotic event occurs after the age of 50, testing for protein C, S, and antithrombin deficiency may be postponed as hypercoagulability due to these disorders usually manifests as thrombosis earlier than the fifth decade. Additional testing directed toward diagnosis of other causes of acquired thrombophilia such as systemic lupus erythematosus, Fibrinogen Thrombophlebitis, liver disease, nephrotic syndrome, polycythemia vera JAK2 mutationsFibrinogen Thrombophlebitis, chronic myelogenous leukemia BCR-ABL1 gene rearrangementFibrinogen Thrombophlebitis, diabetes mellitus, Cushing syndrome, etc.
Positive functional assays can be confirmed by genetic testing in some cases or by demonstration of the abnormality in another family member. Such analysis differentiates homozygous and heterozygous states, providing additional prognostic information. Factor V HR2 allele mutation analysis provides even more prognostic information in factor V Leiden carriers.
Homocysteine elevations may be due to an acquired nutritional Fibrinogen Thrombophlebitis vitamin B 12B 6or folate, Fibrinogen Thrombophlebitis. Acquired causes for antithrombin, Fibrinogen Thrombophlebitis, protein C, and protein S deficiencies can Fibrinogen Thrombophlebitis ruled out by liver function testing, a disseminated intravascular coagulation screen D-dimer, fibrin degradation product, PT, aPTT, fibrinogen, platelet countand a proteinuria test urine albumin.
If all of the aforementioned testing is negative, Fibrinogen Thrombophlebitis, the patient may have a rare disorder that can be identified by testing for factors IX and XI, lipoprotein a [Lp a ], plasminogen activity functionplasminogen activator inhibitor-1 PAI-1and tissue plasminogen activator TPA ; evaluation for dysfibrinogenemia may also be helpful Figure. Testing for rare disorders is only recommended for individuals with a strong personal and family history of thrombosis and negative first line tests or in whom clinical suspicion is high.
Since all thrombophilia etiologies are not yet known, it is possible for all of these tests to be negative. Since individuals with variations in the CYP2C9 and VKORC1 genes may require lower warfarin doses, mutation analysis should be performed to assist in Fibrinogen Thrombophlebitis the initial dosage and to prevent over anticoagulating the patient. Warfarin therapy can Fibrinogen Thrombophlebitis monitored using the prothrombin time test, reported as INR, except in 1 some patients with a strong lupus anticoagulant and 2 patients receiving direct thrombin inhibitors.
For these patients, monitoring with chromogenic factor X is preferred, Fibrinogen Thrombophlebitis. When injectible anticoagulants are used, patients can be monitored using a Xa inhibition assay. See Appendix 2 under Heparin and Fondaparinux for test details. Additional interpretive information, specific Fibrinogen Thrombophlebitis each test, is provided below. Increases homocysteine Oral contraceptives. Increases homocysteine Acute phase reaction, inflammation, infection. The cytochrome P enzyme CYP2C9 participates in the metabolism of a number of important drugs, including warfarin.
Prolongation is also seen in individuals with lupus anticoagulant. A decreased ratio of clotting times obtained with and without exogenous activated protein C is suggestive of activated protein C APC resistance and increased risk of deep vein thrombosis. Such cases are also associated with increased venous thrombosis risk. Decreased levels of antithrombin are associated with an increased risk of both arterial and venous thrombosis and are seen in individuals with hereditary antithrombin deficiency, nephrotic syndrome, colitis, liver disease, active thrombosis, disseminated intravascular coagulation DICthose receiving l -asparaginase therapy or oral contraceptives, and Fibrinogen Thrombophlebitis who are pregnant or have undergone surgery.
Levels are also decreased in individuals receiving heparin, Fibrinogen Thrombophlebitis. Levels in neonates are approximately half of the adult level, which is reached by 6 months of age. Low levels in both the activity and antigen assays indicate type I deficiency, whereas low activity levels in the presence of normal antigen levels indicate type II deficiency dysproteinemia.
Increased levels may be Fibrinogen Thrombophlebitis to oral anticoagulants or heparin cofactor II, Fibrinogen Thrombophlebitis. Increased levels of C4 binding protein may cause decreased levels of free protein S, and subsequent increased risk of thrombosis, and are associated with inflammation, pregnancy, diabetes mellitus, Fibrinogen Thrombophlebitis, SLE, AIDS, allograft rejection, Fibrinogen Thrombophlebitis, estrogen and progesterone administration, and smoking.
IgG antibodies appear to be more predictive of disease activity, while IgM antibody occurs more often in drug-induced disorders and infectious disease eg, syphilis. Higher antibody titers are generally correlated with greater thrombotic risk see Appendix 1, Fibrinogen Thrombophlebitis. Elevated levels are associated with myocardial infarction, deep vein thrombosis, Fibrinogen Thrombophlebitis, pulmonary embolism, DIC and other coagulation disorders, surgery, trauma, sickle cell disease, liver disease, Fibrinogen Thrombophlebitis, severe infection, sepsis, inflammation, malignancy, pregnancy, Fibrinogen Thrombophlebitis, and hyperfibrinolysis, Fibrinogen Thrombophlebitis.
When clinical probability is low, a negative result normal level essentially rules out DVT. An uncorrected dRVVT in the mixing study rules out factor deficiencies, specifically those induced by warfarin therapy. A false-negative dRVVT test may be due to platelet contamination of the plasma. Samples with moderate or severe icterus or lipemia are contraindicated. Such co-inheritance increases the risk of venous thromboembolism 3- to 4-fold when compared with factor V Leiden alone. An individual heterozygous positive for the HR2 allele and negative for factor V Leiden is not at increased risk of thrombosis Fibrinogen Thrombophlebitis to factor V Leiden alone.
However, homozygosity for Fibrinogen Thrombophlebitis V HR2 is associated with increased risk of thrombosis even in the absence of a factor Fibrinogen Thrombophlebitis Leiden mutation.
Factor V Leiden Mutation Analysis. Factor V Leiden confers an approximately 7-fold increase in venous thromboembolic events in heterozygous individuals and an fold increase in homozygous subjects. Although this test is highly specific, identification of a mutation may occur in the absence of APCR in rare cases. A negative result does not rule out APCR or an increased risk of venous thrombosis.
Factor VIII is an acute phase reactant and increased levels are found during periods of stress, postoperatively, and in inflammatory conditions. Elevated levels are also found at birth and during pregnancy. Increased levels are associated with increased risk Pentoxifyllin mit gestörter Blutfluss venous thrombosis, 31 whereas decreased levels are associated with hemophilia A.
The presence of soluble fibrin monomer complexes in plasma indicates intravascular thrombin generation. It Fibrinogen Thrombophlebitis be used to support diagnosis of DIC in the context of other laboratory and clinical findings. Increased levels are associated with acute phase reactions, Fibrinogen Thrombophlebitis, pregnancy, and an increased risk of thrombosis.
Low fibrinogen activity levels are associated with afibrinogenemia, hypofibrinogenemia, or dysfibrinogenemia which may be associated with thrombophilia in rare instancesas well as with DIC, systemic fibrinolysis, pancreatitis, severe hepatic dysfunction, and l -asparaginase or valproate treatment. Individuals with afibrinogenemia or hypofibrinogenemia will have decreased activity and antigen levels.
Individuals with dysfibrinogenemia will typically have decreased activity levels and normal or decreased antigen levels. FDP result from the breakdown of fibrinogen, as well as fibrin, by plasmin.
Normally, the fibrinolytic process is localized to fibrin, Fibrinogen Thrombophlebitis, however, during conditions such as DIC, fibrinolysis spreads and becomes systemic. Persistent elevations indicate that abnormal fibrinolysis and fibrinogenolysis are occurring.
Fondaparinux Sodium Xa Inhibition. Fibrinogen Thrombophlebitis is a synthetic pentasaccharide administered subcutaneously and used to prevent or treat thromboembolic conditions.
Measurement is Fibrinogen Thrombophlebitis to monitor therapeutic levels. The therapeutic range is 1. These ranges are applicable to samples collected approximately 3 hours after administration of the drug. LMWH are prepared by Fibrinogen Thrombophlebitis chemical or enzymatic degradation of unfractionated heparin, and are used in the prevention and treatment of thromboembolic conditions.
Measurement of LMWH in plasma is used to monitor therapeutic levels. The therapeutic and prophylactic ranges for samples collected 4 hours after subcutaneous administration are shown in Table 6. Heparin Anti-Xa Unfractionated Heparin. Unfractionated heparin is used for the prevention and treatment of thromboembolic conditions and measurement is Fibrinogen Thrombophlebitis to monitor therapeutic levels.
When administered as an intravenous infusion, the therapeutic 3 von Vitamin-Varizen is 0. Levels are increased in the following: When coupled with the factor V Leiden mutation, venous thrombosis risk increases synergistically. Homocysteine is decreased in pregnancy except in some women carrying a fetus with a neural tube defectFibrinogen Thrombophlebitis, individuals less than 15 years of age, and individuals taking oral contraceptives or hormone replacement therapy.
Human Platelet Antigen 1 HPA-1 Genotype The HPA-1b platelet antigen polymorphism is Fibrinogen Thrombophlebitis with increased platelet thrombogenecity, neonatal alloimmune thrombocytopenia, and post-transfusion purpura.
Lipoprotein a [Lp a ]. Increased levels of Lp a are observed in patients with coronary artery disease, stroke, cerebrovascular and peripheral vascular disease, and venous thrombosis, Fibrinogen Thrombophlebitis. Substantial increases are secondarily not genetically related observed in nephrotic syndrome and end-stage renal disease. Decreased Lp a levels may be seen in several rare disorders lecithin:
Age. o Usually occurs after 60 years of age · Cause. o Most common cause is deep vein thrombosis (DVT) of lower extremity in >90%.
Symptomatic treatment of hot flushes and associated sweating resulting Fibrinogen Thrombophlebitis the natural or surgical menopause. Improvement of bone-mineral density in patients with established post-menopausal osteoporosis, Fibrinogen Thrombophlebitis.
Cardiovascular or cerebrovascular disorders, Fibrinogen Thrombophlebitis, e. If Livifem is taken sooner than this, Fibrinogen Thrombophlebitis, the frequency of irregular bleeding may be increased. Treatment should be discontinued if signs of thrombo-embolic processes occur, Fibrinogen Thrombophlebitis, if results Fibrinogen Thrombophlebitis liver function tests become abnormal Fibrinogen Thrombophlebitis if cholestatic jaundice appears.
Vaginal bleeding may occur during Livifem therapy, because of an apparently stimulated endometrium due to some estrogen production. Normally such bleeding is of short duration. Bleedings commencing after three months of treatment, or recurrent or Fibrinogen Thrombophlebitis longer duration should be investigated.
In women changing from another form of hormonal substitution therapy to Livifem therapy, it is always advisable to induce Fibrinogen Thrombophlebitis withdrawal bleeding with a progestagen before starting Livifem. Tibolone has been shown to be teratogenic in experimental animals, and should not be used in premenopausal women.
Periodic examinations must be done for endometrial hyperplasia, as well as possible signs of virilisation. In the latter case, Fibrinogen Thrombophlebitis missed dose should be skipped and the next dose should be taken at the normal time. Livifem tablets should be swallowed whole with some water or other drink, Muskat Eigenschaften Krampf at the same time each day.
Vaginal bleeding or spotting may occur, mainly during the first months of treatment. A higher dosage than the recommended may induce vaginal bleeding. Safety of long-term administration has not been established. QuickMarkQuickMarkPatients with the following wo für Krampfadern gehen should be monitored frequently: Renal dysfunction, epilepsy or migraine or a history of these conditions, since the use of steroids with hormonal activity may induce fluid retention.
No examples of interactions between Livifem and other medicines have been reported in clinical practice. However, the following potential interactions should be considered on a theoretical basis: Enzyme-inducing compounds such as barbiturates, carbamazepine, hydantoins, and rifampicin may enhance the metabolism of tibolone and thus decrease its therapeutic effect.