Hyperkoagulaatioon

Hyperkoagulaatioon is a condition characterized by an increased tendency for the blood to clot, leading to thrombosis in veins or arteries. It results from an imbalance in hemostasis, with more procoagulant activity and less fibrinolysis, often in the setting of endothelial injury or reduced flow.

Causes include inherited thrombophilias such as Factor V Leiden and prothrombin G20210A, and deficiencies of protein C, protein S, or antithrombin, as well as acquired factors like surgery, prolonged immobilization, cancer, obesity, pregnancy, estrogen therapy, antiphospholipid syndrome, infection, and inflammation.

Pathophysiology centers on Virchow's triad — hypercoagulability, stasis, and endothelial injury — which together drive clot formation. Inflammation and increased tissue factor expression can amplify coagulation.

Clinical features include venous thrombosis (deep vein thrombosis) and pulmonary embolism as common manifestations. Arterial thrombosis can cause stroke or myocardial infarction, and severe forms may be part of disseminated intravascular coagulation.

Diagnosis involves clinical risk assessment, D-dimer testing, and imaging such as ultrasound for DVT and CT angiography for PE. Blood tests may help identify inherited or acquired thrombophilias.

Management begins with anticoagulation for acute events, typically starting with heparin and transitioning to oral anticoagulants. Duration depends on provoking factors. Preventive measures include mobility, compression devices, addressing risk factors, and, in cancer-associated thrombosis, specific regimens.

Prognosis and prevention depend on the underlying cause and treatment. Recurrence risk varies, and ongoing management focuses on risk-factor modification and appropriate anticoagulation when indicated.