Thrombosis diagnostic evaluation
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Diagnostic Evaluation
Thrombosis formation and Induced ischemia
With the occlusion of the tissue artery in each organ, organ specefic symptoms, clinical and para-clinical signs and laboratory findings my be used to confirm the diagnosis. as discussed below(Intracardia thrombosis is also discussed here):
Unstable angina and MI: With the thrombus formation and occlusion in coronary arteries, cardiac pain new ECG findings( mainly ST segment changes) occur and with cardiac tissue infarction (MI) specefic cardiac enzymes (Troponin, CK-MB) levels elevate in the plasma.
Cerebral stroke and TIA: Beside global or lateralized clinical signs and symptoms of CNS defect, CT scan, MRI and arteriography are used for the diagnosis.
Peripheral arterial occlusions: Clinical signs such as pain, claudication, weakness, paleness and coldness. The diagnosis is confirmed by arteriography.
Atrial thrombosis: There should be an underlying reason; usually a structural heart defect or arrhythmia. The diagnosis is essentially confirmed by echocardiography.
Ventricular thrombosis: The underlying cause is usually myocardial infarction, and some case reports have pointed to the role of hypereosinophilia. The diagnosis is essentially confirmed by echocardiography.
Visceral arteries thrombosis: Mainly consists renal, adrenal, mesenteric and splenic arteries. beside visceral pain and organ specific signs and symptoms, the diagnosis is confirmed by CT angiography, color -doppler sonography and/or MRI as proposed by majority of studies.
Underlying etiology
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
- 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)