Acquired thrombophilia

Haema 2014; 5(1):14-23

by Irini Konstantinidou,1 Maria Liga,2 Athina Mougiou1

1Blood Center, University Hospital of Patras, Rion, Greece,
2Haematology Unit, University Hospital of Patras, Rion Greece

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Thrombophilia is a hypercoagulable state leading to a thrombotic tendency. Acquired thrombophilia is more common than inherited thrombophilia and should be considered when evaluating patients with thrombosis. A significant proportion of thromboembolism events occur in patients with cancer and hematological malignancies and increase the morbidity and mortality. The pathogenesis of thrombosis in cancer, myeloproliferative neoplasms (MPNs), multiple myeloma (MM) and paroxysmal nocturnal hemoglobinuria (PNH) is different and multifactorial and the thrombotic risk varies according to the type of malignancy and its disease stage, and is increased by concomitant patient-related thrombotic risk factors. Pregnancy and postpartum period, combined oral contraceptives (COPs) and hormone replacement therapy (HRT), carry an increased risk of developing venous thrombosis that is increased still further in patients with thrombophilia. The women with thrombophilia are at increased risk, not only of pregnancy-related venous thromboembolism, but also other vascular pregnancy complications, including fetal loss, intrauterine growth restriction and thrombotic microangiopathies. The thrombotic risk of COCs is dependent upon the presence of an undelying hereditary thrombophilia, the estrogen dose, and generation of progestin. Antiphospholipid syndrome (APS) is the most prevalent acquired throm- bophilia and thrombotic complications are the most common cause of death in APS. Additionally, fetal loss and pregnancy morbidity are serious complications of APS, with particular clinical importance. Acquired thrombophilia is a medical challenge and requires vigilance. The optimal primary and secondary prevention of thrombosis in acquired thrombophilia is based on individualized assessment of all risk factors and informed decision for the initiation and duration of anticoagulants.