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The tendency alone rarely sets anything off — what counts is what is done in the risky situations.
Also known as: thrombophilia · factor V Leiden · prothrombin mutation · antiphospholipid syndrome
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Thrombophilia means the blood clots more easily than usual. There are inherited and acquired forms. The commonest inherited one is the factor V Leiden trait; it is widespread in central Europe and on its own usually mild — many carriers never have a thrombosis. The most important acquired form is the antiphospholipid syndrome, because it is treated differently and because it can go with repeated miscarriages. One insight is decisive and surprises people: a tendency alone rarely sets anything off. Almost always something is added — an operation, a cast, a long journey, a pregnancy and the weeks after it, hormonal contraception, a cancer, a long spell in bed. So it is less about the test than about the situations in which prevention is used. And the test has its rules: do not measure during the acute event and not under blood-thinning treatment, because the values are then wrong. Above all it belongs considered beforehand whether the result changes anything at all — for the length of treatment, for contraception, for a pregnancy or for relatives who might share the trait.
With a thrombosis that has a clear cause, a finding often changes nothing about the treatment — then the test mainly brings worry. It becomes worthwhile when it influences a decision.
Freshly formed clots and blood-thinning drugs distort almost all of these values. Measuring is done at a distance, usually weeks after stopping — otherwise everything is needed twice.
Before an operation, with a cast, during a longer spell in bed and around a birth it belongs discussed whether a preventive injection is needed. That is the point where a known tendency really helps.
From about four hours of sitting: stand up every hour, pump the feet while seated, drink enough, no tight waistbands. Anyone with a known tendency also discusses compression stockings.
Preparations containing oestrogen raise the risk, especially in the first year and together with smoking. There are alternatives without this effect — that belongs discussed openly and without pressure.
Sudden breathlessness, a stabbing pain on breathing in, a racing heart or a brief faint are a call to the emergency services and not a question for the next day — especially after a swollen leg.
With a clot at a young age the value is often measured along. It is one of several pieces — and if it is raised, the path leads first to B12 and folate.
A blood thinner prevents new clots — it does not change the inherited tendency, and so the question here is always duration, not cure. After a thrombosis with a clear trigger, three months of treatment follow, even with a proven tendency. Without a trigger, treatment runs longer or permanently. Testing for the tendency changes the treatment less often than assumed — it matters mainly for family planning and for risk situations.
The most common inherited tendency, the factor V Leiden change, is carried by about five in a hundred people in Europe — most never have a thrombosis. The risk rises above all in combination: the pill, pregnancy, surgery, long sitting, smoking. After a thrombosis with a clear trigger, treatment runs three months; without a trigger, longer. A test changes the duration less often than assumed and is not done during the acute episode.
Before the age of fifty and without a recognisable cause is the classic reason to think of a tendency at all.
Repeated clots, especially without a cause, change the question: it is then less about the cause than about how long treatment should last.
Clots in the abdominal veins, in the veins of the brain or in the arm are rare and a reason of their own to look more closely — including for causes outside the clotting system.
Several close relatives with thromboses or lung embolisms, especially at a young age, speak for an inherited trait. That changes above all how prevention is handled in risky situations.
Several losses, especially later in a pregnancy, belong to the workup of the antiphospholipid syndrome. This form is treatable, and the treatment changes the outcome.
Belongs to the workup of the antiphospholipid syndrome, the most important acquired form. The value cannot be judged under blood-thinning treatment and is confirmed after twelve weeks.
A natural counterpart to clotting. In the acute event and under certain blood thinners it is falsely low — so it is measured only at a distance.
A raised value belongs to the picture and can often be lowered with B12, folate and B6. It is one of the few points where one can change something oneself.
It does not measure a tendency but whether something is clotting and being dissolved right now. After stopping the blood thinner it helps to judge how high the risk of a repeat is.
Reliably lower raised homocysteine — whether that prevents thromboses is not shown by the studies.
On warfarin-type blood thinners vitamin K is the counterpart. Not forbidden, but steady — cabbage and green leaves are not the problem, the swing in amount from week to week is.
From about 3 g EPA+DHA a day the bleeding time lengthens measurably. Together with a blood thinner that belongs discussed — it is not added protection but added bleeding risk.
From fermented soybeans; in the test tube it dissolves fibrin. In humans no benefit is shown for a tendency to thrombosis, and as a replacement for a prescribed blood thinner it is certainly not one.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Here the combination decides: a factor V Leiden trait alone is common and mostly harmless — together with the combined pill the risk multiplies. That is why a thrombosis in the family belongs mentioned before the prescription.
Mini-pill, hormonal coil and implant do not raise the risk appreciably as things stand. For women with a known tendency to thrombosis that is the most important practical difference of all.
An overactive thyroid raises several clotting factors — with a thrombosis and no obvious trigger TSH belongs on the list. The link is described and rarely thought of.
Do not avoid it, keep it steady. Skipping green salad and then eating a lot of it makes the INR swing. With the newer blood thinners vitamin K plays no role.
A raised homocysteine belongs to the work-up. Folate, B12 and B6 reliably lower the value; whether that means fewer clots is not shown.
On warfarin-type blood thinners K2 preparations act at exactly the point where the medicine works. With the newer medicines this does not matter — the difference is important.
The calf muscle pump is the best protection against stasis. On long journeys standing up hourly counts more than any supplement.