Dawaa Reference

Clinical reference

Thrombophilia (Clotting Tendency)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Hypercoagulability - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538251/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD78.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Thrombophilia (Clotting Tendency) - disease-level clinical article (thrombophilia-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • When clots occur, they most often affect the deep leg veins or lungs, though superficial leg veins or the cerebral, portal, or hepatic veins can also be affected
  • An isolated pulmonary embolism without any leg clot can occur but is actually less common in factor V Leiden carriers than in the general population, a pattern called the factor V Leiden paradox
  • Cerebral vein clots are a risk, particularly with oral contraceptive use, and factor V Leiden has also been linked to a higher risk of Budd-Chiari syndrome
  • Stroke risk is modestly increased, particularly in women, smokers, and younger patients

Tests (12)

  • ASH guidelines discourage thrombophilia testing after a first DVT or PE, since it is costly without clear clinical benefit
  • Testing is considered for VTE occurring before age 50
  • Testing is also considered for clots in unusual sites such as the ovarian, portal, or renal veins
  • An unexplained arterial clot is another reason to test for thrombophilia
  • A strong family history of thrombophilia also prompts testing
  • A hospitalized patient who clots despite preventive anticoagulation, with no other explanation, is a testing candidate
  • Unexplained recurrent DVT or PE is also an indication for testing
  • Testing is generally skipped after a first, provoked clot or one occurring after age 50
  • Diagnosis uses either genetic mutation analysis or a functional APC resistance coagulation test
  • A positive functional APC resistance test should be confirmed with genetic testing
  • PCR-based mutation testing works because a restriction enzyme cuts normal DNA but not the mutated gene, producing a distinct gel banding pattern
  • The functional APC resistance assay is cheaper but can give a falsely normal result in patients on direct thrombin or factor Xa inhibitors, or with a lupus anticoagulant

If not this — what else fits (12)

  • Prothrombin G20210A mutation
  • Protein S deficiency
  • Protein C deficiency
  • Antithrombin (AT) deficiency
  • Malignancy
  • Pregnancy or use of oral contraceptives
  • Immobilization/obesity
  • Nephrotic syndrome
  • Antiphospholipid syndrome
  • Paroxysmal nocturnal hemoglobinuria
  • Myeloproliferative disorders
  • Medications like tamoxifen, thalidomide, or lenalidomide

SourceStatPearls "Factor V Leiden Mutation" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Inherited or acquired tendency to abnormal blood clotting. Diagnosis requires specialist coagulation work-up; GP gives urgent advice and initial anticoagulation if a clot is suspected, and may continue long-term anticoagulation once a specialist has set the plan. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Inherited or acquired tendency to abnormal blood clotting. Diagnosis requires specialist coagulation work-up; GP gives urgent advice and initial anticoagulation if a clot is suspected, and may continue long-term anticoagulation once a specialist has set the plan.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Indefinite anticoagulation is strongly recommended for unprovoked, life-threatening VTE, recurrent VTE, or VTE at unusual locations.
  • RED FLAG - Homozygous thrombophilia patients undergoing surgery require prophylactic anticoagulation as a high-risk population.
  • RED FLAG - Unilateral leg swelling or pain (possible DVT), or sudden breathlessness or chest pain (possible PE).
  • Features that should prompt referral include recurrent pregnancy loss and a clot at a young age or without an obvious trigger.

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