TAILIEUCHUNG - Chapter 111. Venous Thrombosis (Part 3)

Thrombophilia Testing Testing for prothrombotic abnormalities outside the setting of abundant familial thrombophilia serves no purpose. A positive test does not help in the diagnosis of thrombosis, nor does it predict the risk of recurrent thrombosis, nor, therefore, does it affect long-term preventive strategies. Hereditary Thrombophilia Individuals from families with a hereditary tendency for venous thrombosis generally have a more severe thrombotic tendency than individuals not from such families. Even when the genetic defect is the same in the two groups, those with hereditary thrombophilia from affected families have their first thrombosis at a young age (20–35 years), few fail to develop. | Chapter 111. Venous Thrombosis Part 3 Thrombophilia Testing Testing for prothrombotic abnormalities outside the setting of abundant familial thrombophilia serves no purpose. A positive test does not help in the diagnosis of thrombosis nor does it predict the risk of recurrent thrombosis nor therefore does it affect long-term preventive strategies. Hereditary Thrombophilia Individuals from families with a hereditary tendency for venous thrombosis generally have a more severe thrombotic tendency than individuals not from such families. Even when the genetic defect is the same in the two groups those with hereditary thrombophilia from affected families have their first thrombosis at a young age 20-35 years few fail to develop thrombosis in their lifetime and many have recurrent disease. Early studies on thrombotic risk associated with prothrombotic defects were based on such families and overestimated risks for all patients with thrombophilie defects. Generally individuals from such families need not be treated differently than others except 1 oral contraceptives containing estrogens should be discouraged in all and 2 postpartum anticoagulant prophylaxis should be considered in those with prothrombotic defects. Long-term treatment can be considered after a first episode of thrombosis but only in high-risk families particularly those with antithrombin deficiency. Thrombosis at Rare Sites One in 25 venous thromboses occurs in the arm while other even more rare locations are the brain cerebral vein thrombosis the digestive system mesenteric vein thrombosis and the liver portal vein thrombosis and hepatic vein thrombosis also known as Budd-Chiari syndrome . Thrombosis of the arm is almost invariably associated with central venous catheters. Deteriorating liver function and portal hypertension may point to thrombosis in the hepatic or portal veins neurologic defects to cerebral vein thrombosis and severe abdominal complaints to mesenteric vein thrombosis. In rare cases DVT

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