After completing this chapter, the student will be able to:

1. Define thrombophilia and thrombosis.

2. Indicate risk factors associated with inherited and acquired thrombosis.

3. List hemostatic changes responsible for pathological thrombosis.

4. Describe antithrombin, protein C, and protein S with regard to properties, mode of action, factors affected, and complications associated with their deficiencies.

5. List inherited risk factors for thrombosis and their frequency of occurrence.

6. List the most common acquired risk factors associated with thrombosis.

7. Describe activated protein C resistance with regard to pathophysiology, mode of action, and associated complications.

8. Describe heparin-induced thrombocytopenia in regard to the cause, patient's clinical manifestations, and pathophysiology of the disease.

9. Name the laboratory tests used for the diagnosis of factor V Leiden and heparin-induced throm-bocytopenia.

10. List the types of anticoagulant drugs used for the treatment of thrombotic disorders.

11. Explain the mechanism of action of each anticoagulant drug commonly used for the treatment of thrombotic disorders.

12. Name the most common laboratory test used for monitoring of heparin therapy.

13. Name the most common laboratory test used for monitoring of Coumadin therapy.

Hypercoagulability refers to environmental, inherited, and acquired conditions that predispose an individual to thrombosis. Thrombosis is the formation of a blood clot in the vasculature. Two types of thrombosis are known: arterial and venous thrombosis. Arterial thrombosis is mainly composed of platelets with small amounts of red cells and white cells whereas venous thrombosis is composed of fibrin clot and red cells. Thrombosis may result from vascular injury, platelet activation, coagulation activation, defects in the fibrinolytic system, and defects in physiological inhibitors. Arterial and venous thrombosis along with complicating thromboembolism is the most important cause of death in the developed countries. More than 800,000 people die annually from myocardial infarction (MI) and thrombotic stroke in the United States.1 It has also been reported that venous thromboembolic disease is the most common vascular disease after atherosclerotic heart disease and stroke.1

This chapter will focus on the physiology and pathology of thrombosis, thrombotic disorders, laboratory diagnosis, and anticoagulant therapy.

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