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Prim Care. 2016 Dec;43(4):619-635. doi: 10.1016/j.pop.2016.07.001.

Thrombosis, Hypercoagulable States, and Anticoagulants.

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Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:


Patients with derangements of secondary hemostasis resulting from inherited or acquired thrombophilias are at increased risk of venous thromboemboli (VTE). Evaluation of a patient with suspected VTE proceeds via evidence-based algorithms that involve computing a pretest probability based on the history and physical examination; this guides subsequent work-up, which can include D dimer and/or imaging. Testing for hypercoagulable disorders should be pursued only in patients with VTE with an increased risk for an underlying thrombophilia. Direct oral anticoagulants are first-line VTE therapies, but they should be avoided in patients who are pregnant, have active cancer, antiphospholipid antibody syndrome, severe renal insufficiency, or prosthetic heart valves.


Anticoagulation; Deep venous thrombosis; Pulmonary embolism; Thrombophilia; Venous thromboembolism

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