When you cut or injure yourself, your body stops the bleeding by forming a blood clot. Proteins and particles in your blood, called platelets, stick together to form the blood clot. The process of forming a clot is called coagulation. Normal coagulation is important during an injury, as it helps stop a cut from bleeding and starts the healing process.
However, the blood shouldn’t clot when it’s just moving through the body. If blood tends to clot too much, it is referred to as a hypercoagulable state or thrombophilia.
Hypercoagulable states can be dangerous, especially when these conditions are not properly identified and treated. People with hypercoagulable states have an increased risk for blood clots developing in the arteries (blood vessels that carry blood away from the heart) and veins (blood vessels that carry blood to the heart). A clot inside a blood vessel is also called a thrombus or an embolus.
Blood clots in the veins or venous system can travel through the bloodstream and cause deep vein thrombosis (a blood clot in the veins of the pelvis, leg, arm, liver, intestines or kidneys) or a pulmonary embolus (blood clot in the lungs).
Blood clots in the arteries can increase the risk for stroke, heart attack, severe leg pain, difficulty walking, or even the loss of a limb.
Hypercoagulable states are usually genetic (inherited) or acquired conditions. The genetic form of this disorder means a person is born with the tendency to form blood clots. Acquired conditions are usually a result of surgery, trauma, medications or a medical condition that increases the risk of hypercoagulable states.
Inherited hypercoagulable conditions include:
Acquired hypercoagulable conditions include:
Careful Medical History
Certain conditions increase a person’s risk for developing blood clots, but do not necessarily indicate a genetic hypercoagulable state. Therefore, a careful evaluation of the patient’s personal and family medical history is needed.
Patients may be candidates for screening for hypercoagulable states if they have:
If you have one of the previously listed conditions, your doctor may recommend blood tests to further evaluate your condition.
These tests should be performed at a specialized coagulation laboratory and interpreted by a pathologist or clinician with expertise in coagulation, vascular medicine or hematology.
Ideally, the tests should be done when you are not having an acute clotting event.
The most common lab tests include:
Some of the tests help detect the antiphospholipid antibody syndrome or dysfibrinogenemias- conditions that can be associated with hypercoagulable states.
Tests used to help diagnose inherited hypercoagulable states include:
*Factor V Leiden and prothrombin gene mutation (G20210A) are the most commonly identified genetic defects that increase a person’s risk for blood clotting.
**Additional lab tests, such as measurement of free (active) and total protein S antigen levels, may be required in order to validate protein S activity assay results.
Other tests used to help diagnose acquired hypercoagulable states include tests for:
*The presence of antiphospholipid antibodies (ACA) and a lupus anticoagulant (LA) is important when evaluating someone who has had recurrent miscarriages and venous or arterial thrombosis.
Testing helps identify whether the patient is at risk for further clotting and helps determine an appropriate course and length of treatment to prevent future clots. Testing also may help to identify relatives who don’t currently have symptoms but may be at risk.
In most cases, treatment is only needed when a blood clot develops in a vein or artery. Anticoagulants decrease the blood’s ability to clot and prevent the formation of additional clots.
Anticoagulant medications include:
You and your family will be instructed on how to take the anticoagulant medication that is prescribed.
Your doctor will talk to you about the benefits and risks of these medications. This information, along with your diagnosis, will help determine the type of anticoagulant medication you will take, how long you will need to take it, and the type of follow-up monitoring you need.
As with any medication, it is important to know how and when to take your anticoagulant according to your doctor’s guidelines, and to have frequent blood tests, as ordered by your doctor.
If you're prescribed warfarin (Coumadin):
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:
Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.
You may also use our MyConsult second opinion consultation using the Internet.The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:
Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Additional information about vascular treatment options can be found at:
Diagnostic tests are used to diagnose coronary artery disease and the most effective treatment method.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 04/25/2019