Hypercoagulable syndromes: evaluation and management strategies for acute limb ischemia

Acute limb ischemia secondary to peripheral arterial thrombosis is a relatively uncommon but ominous form of vascular accident. Select inherited and acquired hypercoagulable states appear to contribute to an initial arterial thrombosis and, more importantly, recurrent thrombotic events. Mounting interest in hypercoagulability, the increased availability of hypercoagulable state "profiles," and enhanced ability to identify an abnormality in tested patients have promoted widespread testing. Unfortunately, widespread testing has had a limited beneficial impact on the management of acute limb ischemia. Ideally, costly and specialized testing should be limited to situations in which the results will have a tangible impact on patient care. Clear goals of testing should be determined before testing is performed. This article addresses a practical approach to hypercoagulable state testing in patients with acute limb ischemia with a focus on abnormalities that impact patient management.