Wednesday, September 02, 2009
Hypercoagulable workup (incl effects warfarin on tests)
hat tip David Gordon, MD Professor/Chairman Neurology at OKL
Hypercoagulable Profile
Protein C
Protein S free and total
Antithrombin III
Fibrinogen
Factor VII
Factor VIII
Activated protein C resistance (APCR)
Factor V Leiden mutation
Prothrombin G20210A mutation
Anticardiolipin antibodies
Anti-beta-2-glycoprotein I antibodies
Antiphosphatidylserine antibodies
Lupus anticoagulant
Lipoprotein (a)
C-reactive protein
Methyltetrahydrofolate reductase C677T and A1298C
Sickle prep (if African heritage)
Affect of Coumadin on Hypercoagulable Profile
Protein C (may be decreased with warfarin)
Protein S free and total (may be decreased with warfarin)
Antithrombin III (not affected by warfarin)
Fibrinogen (not affected by warfarin)
Factor VII (may be affected by warfarin)
Factor VIII (not affected by warfarin)
Activated protein C resistance (must alter methods to compensate for warfarin)
Factor V Leiden mutation (not affected by warfarin)
Prothrombin 20210 mutation (not affected by warfarin)
Anticardiolipin antibodies (not affected by warfarin)
Anti-beta-2-glycoprotein I antibodies (not affected by warfarin)
Antiphosphatidylserine antibodies (not affected by warfarin)
Lupus anticoagulant (screening tests not affected by warfarin, but “mixing studies” to
confirm are affected by warfarin)
Lipoprotein (a) (not affected by warfarin)
C-reactive protein (not affected by warfarin)
Methyltetrahydrofolate reductase C677T and A1298C (not affected by warfarin)
Sickle prep (if African heritage) (not affected by warfarin
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1 comment:
Agree with Dr Britt's and others list. However, as many presumed arterial
infarcts are due to paradoxical embolism, I believe the division into an
arterial panel and a venous panel is somewhat artificial; such a division often
leads one into a situation where treatment has begun (perhaps prematurely, in
this age of efficiency and high /rapid turnover from in-patient to rehab or
discharge), clouding issues whether Proteins or Protein C might have been
implicated. Thus, in terms of efficiency, it may be best to obtain a thrombosis
panel.
I should like to add d-dimer, fibrinogen, plasminogen, and alpha-2-antiplasmin
to the panel. In selected cases, one must not forget the existence of other
antiphospholipid antibodies....foremost, anti-phosphatidyl-serine.
F. Buonanno, M.D.
CardioNeurology Clinic/ Stroke Service
Massachusetts General Hospital
Co-Director, Pediatric Stroke Service
Mass General Hospital for Children
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