Hypercoagulable states: an algorithmic approach to laboratory testing and update on monitoring of direct oral anticoagulants

Abstract

Hypercoagulability can result from a variety of inherited and, more commonly, acquired conditions. Testing for the underlying cause of thrombosis in a patient is complicated both by the number and variety of clinical conditions that can cause hypercoagulability as well as the many potential assay interferences. Using an algorithmic approach to hypercoagulability testing provides the ability to tailor assay selection to the clinical scenario. It also reduces the number of unnecessary tests performed, saving cost and time, and preventing potential false results. New oral anticoagulants are powerful tools for managing hypercoagulable patients; however, their use introduces new challenges in terms of test interpretation and therapeutic monitoring. The coagulation laboratory plays an essential role in testing for and treating hypercoagulable states. The input of laboratory professionals is necessary to guide appropriate testing and synthesize interpretation of results.

Keywords: Algorithmic approach; Antiphospholipid syndrome; Direct oral anticoagulant; Hypercoagulability; Venous thromboembolism.

Fig. 1

Comprehensive hypercoagulability testing panel using a diagnostic algorithm. Abbreviations: aPTT, activated partial thromboplastin time; B2GP1, beta2 glycoprotein 1; CRP, C-reactive protein; DRVVT, dilute Russell's Viper Venom test; MTHFR, methylenetetrahydrofolate reductase; PL, phospholipid; PNP, platelet neutralization procedure; PT, prothrombin time; SNP, single nucleotide polymorphism.