hypocoagulable

Hypocoagulable refers to a reduced tendency of the blood to clot, resulting in an increased risk of prolonged bleeding after injury or surgery. It is the opposite of a hypercoagulable state, in which clots form too readily. Hypocoagulability can arise from genetic disorders, acquired conditions, or medications that impair the coagulation system.

Common congenital causes include deficiencies of coagulation factors (such as factor VIII in hemophilia A and factor IX in hemophilia B) and disorders of von Willebrand disease, which affect platelet adhesion and the function of clotting factors. Acquired causes encompass vitamin K deficiency, liver disease (which impairs synthesis of multiple coagulation factors), platelet dysfunction or low platelet counts, and consumption or dilutional coagulopathy in severe illness. Anticoagulant medications (for example warfarin) and certain antiplatelet or anticoagulant drugs can also produce a hypocoagulable state.

Clinical features typically involve easy bruising, mucosal bleeding (such as nosebleeds or gum bleeding), prolonged bleeding after injuries or procedures, and in severe cases spontaneous bleeding. Laboratory testing may show prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT), with normal platelet counts; specific factor assays or mixing studies can help identify the underlying cause.

Management focuses on addressing the underlying cause and controlling bleeding. This can include vitamin K administration for deficiency or warfarin reversal, administration of clotting factor concentrates or fresh frozen plasma, desmopressin for certain von Willebrand disease cases, platelet transfusion for severe thrombocytopenia or platelet dysfunction, and treating liver disease or stopping offending medications where appropriate.