Thrombosis diagnostic evaluation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Diagnostic Evaluation

Thrombosis Formation and Induced Ischemia

The diagnostic evaluation of thrombosis begins with history and physical examination to assess for occlusion of the tissue artery/vein in each organ and to assess for organ-specific symptoms. Clinical and para-clinical signs and laboratory findings may be used to confirm the diagnosis. Individual organ thrombosis is discussed below:

• Unstable angina and MI:
  • Clinical signs and symptoms: chest pain, shortness of breath, substernal discomfort
  • Imaging and other diagnostics: new ECG findings (mainly ST segment changes and T wave inversions), elevation of cardiac tissue infarction (MI)-specific cardiac enzymes (troponin, CK-MB)

• Cerebral stroke and TIA:
  • Clinical signs and symptoms: numbness, weakness, tingling, paresis, hemiplegia, slurred speech, imbalance
  • Imaging and other diagnostics: occlusion or thrombosis noted on CT head or MRI

• Peripheral arterial occlusions:
  • Clinical signs and symptoms: weakness, paresthesia, numbness, claudication
  • Imaging and other diagnostics: filling defect or perfusion defect on CT angiography

• Atrial thrombosis:
  • Clinical signs and symptoms: chest pain, shortness of breath, dyspnea on exertion
  • Imaging and other diagnostics: echocardiography

• Ventricular thrombosis:
  • Clinical signs and symptoms: chest pain, shortness of breath, dyspnea on exertion
  • Imaging and other diagnostics: echocardiography

• Visceral arteries thrombosis:
  • Clinical signs and symptoms: visceral pain, abdominal pain
  • Imaging and other diagnostics: CT angiography of the renal, adrenal, mesenteric or splenic arteries; Doppler ultrasound

Laboratory Findings

cDNA-PCR Assays for Gene Mutations and Polymorphisms

• 4G/5G polymorphism of the plasminogen activator inhibitor-1 gene (PAI-1)
• Cystathionine beta synthetase (CBS) CBS T833C & G919A
• Factor V Leiden
• Glycoprotein IIIa A1/A2 (platelet glycoprotein)
• Methylenetetrahydrofolate reductase (MTHFR) MTHFR C677T
• Prothrombin G20210A

Serologic (blood) Tests

• Anticardiolipin antibodies (ACLA) IgG and IgM ACLA
• Beta-2-glycoprotein antibodies
• Antithrombin III
• Factor VIII
• Homocysteine
• Lupus anticoagulant (LA)
• Protein C
• Protein S

Evaluation of Hypofibrinolysis

• 4G/5G polymorphism of the plasminogen activator inhibitor-1 gene (PAI-1) (requires cDNA-PCR assay for gene mutation)
• Lipoprotein a (Lp a)