Dawaa Reference

chronic

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.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.