First, lets get the big medical terms out of the way. Thrombophilia = clot easily. (Thrombus= clot, phile= like, ie you like to clot)
Inherited means you got it in your genes from your family (not from the store, from drinking diet drinks, or from too much sun exposure). So chances are, if you look into that family tree, you will see others with issues as well.
A recent retrospective study was published in our Plastic Surgery Journal (May 2010) entitled “Hereditary Coagulopathies: Practical Diagnois and Management for the Plastic Surgeon.” Why would we plastic surgeons need our own special review? Because we do surgeries where bleeding is a big issue. Any surgery which requires a flap- facelift, breast reduction, body lift, and tummy tuck- has a large raw surface area. Anything which “thins your blood” causes us an issue. So why does this matter here? Isn’t this blog about people who clot TOO much, not too little? Yes it is. The issue is many surgeries inject lovenox or heparin to counter the DVT risk, ie they inject blood thinners to combat those who clot too easily. For us plastic surgeons, things which thin the blood may protect you from the complication of DVT only to cause another complication–bleeding. That isn’t good. So we have to weigh risk vs. benefit.
SO.
Inherited thrombophelia stats:
- They are found frequently in those with venous thromboembolism
- They recur: 30% had a recurrence within an 8 year follow up
- These patients have higher risk for DVT/PE than the normal population
- Risk increase is based on the type and number of thrombophilias present
They are divided into two groups:
ABNORMAL FUNCTION OF FACTORS
- Activated protein C, Factor V Leiden
- Prothrombin
- Elevated levels of Factors VIII, IX, and XI
DEFICIENCIES OF FACTORS (These tend to be worse)
- Protein S deficiency
- Protein C deficiency
- Antithrombin deficiency
The most common defect, factor V Leiden occurs in 5-15% of the general population. If you are a heterozygote, your risk is 3-10 times that of the general population for DVT, but this risk significantly increases with “acquired” hypercoagulability factors like birth control pills. Homozygotes have an increased relative risk of 79 times.
Again, DVT and PE is a big deal and one we work to avoid. If you have any family or personal history of clotting, you should have a work up by a hematologist to assess your risk and perioperative management.