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Coagulation

Hereditary thrombophilia / hypercoagulopathies

Elevated coagulation factor levels in plasma


Reviewer: Jeremy Parsons, M.D. (see Reviewers page)
Revised: 21 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● May predispose to thrombosis

Factor I (fibrinogen):
● High levels associated with increased risk for myocardial infarction and arterial thrombosis
● Often elevated in hospitalized patients since it is an acute phase reactant
● Not recommended to measure to assess thrombotic risk, since assay has not been standardized
● Independent effect appears to be modest
● Insufficient clinical data to demonstrate that lowering fibrinogen will prevent ischemic heart disease

Factor II (prothrombin):
● High levels associated with increased risk of venous thrombosis
● See also prothrombin G20210A mutation
● Standard activity assays are not useful in assessing individual patients for hyperprothrombinemia - use the genetic assay

Factor V:
● High levels associated with increased risk of arterial thrombosis
● Not recommended to measure to assess thrombotic risk, since not associated with venous thrombosis
● Only one study relates factor V activity and ischemic heart disease
● Methodology is inadequate to assess individual levels; there are no studies showing that reduction of factor V activity will reduce risk for ischemic heart disease or stroke

Factor VII:
● High levels or certain genetic polymorphisms are associated with increased risk for myocardial infarction, but not an independent risk factor
● Levels are associated with triglyceride and cholesterol levels

Factor VIII:
● High levels associated with increased risk of venous thrombosis and arterial thrombosis
● However normal range varies about 3 fold, levels vary with ABO blood type (15% lower with type 0) and is acute phase reactant
● If no acute stress reaction, no aerobic exercise in past 24 hours, no estrogenic effects, then baseline value >150% is a risk factor
● Not recommended to assess individual risk because no established standard for elevated levels, tremendous interlaboratory variation

Factor IX:
● High levels associated with increased risk of venous thrombosis
● Not recommended to assess individual venous thrombosis risk due to limited amount of clinical data and limited availability of factor IX ELISA

Factor XI:
● High levels (>121%) associated with increased risk of venous thrombosis
● Not recommended to assess individual venous thrombosis risk because:
      (1) factor XI assays are not generally available
      (2) one step clotting assay and PTT based assays may be too variable
      (3) may be affected by other variables

Factor XIII:
● Polymorphism Val34Leu may protect against venous thrombosis (Arch Pathol Lab Med 2002;126:1391)

von Willebrand factor:
● High levels associated with increased risk of arterial thrombosis
● Not recommended to assess individual thrombotic risk because it is not an independent risk factor, and no studies show that reduction of vWF levels reduces risk of ischemic heart disease, stroke or peripheral arterial disease

Additional references
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Arch Pathol Lab Med 2002;126:1405, Thromb Haemost 2009;102:936
Goodnight Jr., Scott, & Hathaway, William (Eds.). (2001). Disorders of hemostasis & thrombosis: A clinical guide. New York, NY: McGraw-Hill.

End of Coagulation > Hereditary thrombophilia / hypercoagulopathies > Elevated coagulation factor levels in plasma


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