Thrombophilia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2]

Overview

Thrombophilia may be classified into three subtypes: inherited or primary hypercoagulable states, acquired or secondary hypercoagulable states, and mixed/unknown.

Classification

• Prothrombotic states which can be origin from venous or both venous and arterial clots might be classified into heritable, acquired or mixed resulting from the interactions between the environment (e.g. oestrogen use, obesity or other lifestyle factors) and genetic factors as elaborated in the following Table 1.

Table 1: Classification of thrombophilias

Type of classification	Medical conditions
Inherited thrombophilia or primary hypercoagulable state	Activated protein C resistance (Factor V Leiden), Prothrombin gene mutation (Prothrombin G20210A), Antithrombin deficiency, Protein C, Protein S deficiency, Dysfibrinogenemia, Non-O blood type
Acquired thrombophilia or secondary hypercoagulable state	Age, Immobilization, Trauma/major surgery, Orthopedic surgery, Malignancy, Myeloproliferative disorders (polycythemia vera, essential thrombocythemia, hyperviscosity), Pregnancy, Estrogen and testosterone (oral contraceptives, hormone replacement therapy, and selective estrogen receptor modulator), Obesity, Heart Failure, Cirrhosis, Chronic renal disease, Nephrotic syndrome, Antiphospholipid syndrome (APLS) or lupus anticoagulant, Heparin-induced thrombocytopenia (HIT), Disseminated intravascular coagulopathy (DIC), Paroxysmal nocturnal hemoglobinuria (PNH), Autoimmune disorders (Vasculitis, Celiac disease, Inflammatory bowel disease), Thrombotic microangiopathy, Sickle cell disease, Drug related (chemotherapies including L-aspariginase, mitomycin; infusion of clotting factors including prothrombin complex concentrates, cryoprecipitate; drugs including hydralazine, procainamide, or phenothiazines can promote lupus anticoagulant formation)
Mixed/Unknown	Hyperhomocysteinemia,
Arterial thrombotic disorders	Example