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August 2010, Volume 40 Number 8 , p 52 - 56


  • Corin R. Gigler BSN, RN, CACP
  • Lynn B. Oertel MS, ANP, CACP


OUR BLOOD VESSELS SUFFER small injuries every day, from events as minor as a scraped knee or a simple paper cut. To stop the bleeding, clotting factors in the bloodstream are activated to form fibrin. Along with platelets and red blood cells (RBCs), fibrin helps form a blood clot. The process of hemostasis prevents excessive blood loss after an injury. (For details, see Hemostasis in five easy steps.)Alterations in hemostasis include bleeding disorders (when clotting is insufficient to stop bleeding) and hypercoagulability states (when inappropriate or excessive clotting occurs leading to thrombosis). This article focuses on hypercoagulability states by reviewing two common disorders: factor V Leiden (also called activated protein C resistance) and prothrombin G20210A mutation. Because of its association with such common conditions as cancer, infections, and systemic lupus erythematosus, we'll also describe an acquired hypercoagulable state known as antiphospholipid antibody syndrome. Patients who have one of these conditions are at increased risk for complications such as venous thromboembolism (VTE) and arterial thrombosis (which can lead to stroke) when they're hospitalized for other conditions, so this article also describes how to assess and manage your patient.Activation of the coagulation system and thrombus formation can be caused by primary (genetic) or secondary (acquired) disorders that increase procoagulation factors or reduce anticoagulation factors. Factor V Leiden and prothrombin G20210A mutation (which we'll focus on) are the most common hereditary hypercoagulable states; hereditary deficiencies of protein C, protein S, or antithrombin III are less common. Factor V Leiden and prothrombin G20210A mutations increase a white patient's risk of a first unprovoked episode of venous thrombosis, but the risk of recurrent events is less clear.1Interestingly, although the incidence of factor V Leiden and prothrombin G20210A is greater than that

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