The availability of a wide range of assays to evaluate the hypercoagulable state has enhanced the diagnosis of inherited and acquired thrombotic events. However, the assays are expensive and time consuming. These laboratory tests should be considered for patients in whom the test results will impact the choice, intensity, and duration of anticoagulant therapy, family planning, and prognosis.1
The clinical events that justify laboratory evaluation of hypercoagulable states are listed in Table 19.4. Patients who lack a positive family history should be evaluated for an acquired form of thrombosis such as malignancy, myeloproliferative disorders, and aPL antibodies.1,7 Laboratory assays should not be done at the time of acute thrombosis or when the patient is receiving any anticoagulant therapy because it may affect the results of the assays.1 Levels of fibrin degradation products and (D-dimer) are increased in patients with acute venous thromboembolism. Lack of elevated D-dimer in patients evaluated for acute DVT or PE has an excellent negative predictive value for thrombosis.1
Functional tests are preferred over immunologic assays. The screening laboratory tests used for evaluation of patients suspected of having a hypercoagulable state are summarized in Table 19.5.
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