Clotting problems: diagnosis and management of underlying coagulopathies

Vessel wall injury, stasis, and blood hypercoagulable state are major predisposing factors of thrombosis. Although, a procoagulable factor is found in half of patients with venous thromboembolism, relatively little is known about coagulopathies that predispose to arterial thromboembolism or unexplained arterial revascularization thrombosis. Those hypercoagulable states can be inherited or acquired and related to either an increase of a procoagulable factor or a decrease of an anticoagulation agent. However, most thrombotic episodes seem to occur with additive combination of acquired and inherited predisposing factors. Therefore, controversy exists as to which patients and family members to test for thrombophilia and which patients to treat with life-long anticoagulation. The aim of this review is to provide a practical overview with guidelines for detecting, and treatment of, the principal underlying coagulopathies that a vascular surgeon should be aware of in his/her practice and for the care of patients with vascular disease.