hypercoagulable

Hypercoagulable describes a state in which the blood has an increased tendency to clot. The term is often used interchangeably with thrombophilia. It results from an imbalance between coagulation and anticoagulation pathways in the hemostatic system. Hypercoagulability can be inherited, acquired, or occur due to a combination of factors.

Inherited causes include genetic variations that elevate clotting potential or reduce natural anticoagulants. The most common are Factor V Leiden and the prothrombin G20210A mutation, along with deficiencies of protein C, protein S, or antithrombin. Rare defects affecting fibrinolysis or other regulators also occur. Acquired causes include antiphospholipid syndrome, active cancer, pregnancy and the postpartum period, estrogen-containing medications, prolonged immobility, obesity, smoking, inflammatory diseases, nephrotic syndrome, and liver disease.

Diagnosis relies on history and testing for thrombophilia in selected individuals. Tests may include protein C and S, antithrombin, Factor V Leiden, and prothrombin gene mutation panels, among others. Results can be affected by acute thrombosis, current anticoagulation, pregnancy, age, and prior therapies, so testing is not universal and must be interpreted cautiously.

Management centers on treating thrombosis and reducing recurrence risk. Acute events are treated with standard anticoagulation; the decision to continue long-term or indefinite therapy depends on the causative factor and recurrence risk. Risk modification includes avoiding estrogen-containing therapies, maintaining a healthy weight, staying active, and managing comorbidities. Special considerations apply during pregnancy and surgery.