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In their excellent review titled "An Update on Hypercoagulable Disorders," Federman and Kirsner¹ recommend testing patients with a history of thrombosis at an early age for deficiencies of anti–thrombin III, protein C, and protein S and for the presence of antiphospholipid antibodies, factor V Leiden, prothrombin 20210A mutation, and hyperhomocysteinemia.

One must argue, however, that ordering all these tests would be an unreasonable drain on resources. Ordering the so-called hypercoagulation panel, though attractive, may have an economic and even a therapeutic shortcoming impact. Prioritizing the need to test and the yield of each test would seem a more appropriate approach.

Conceding that factor V Leiden and factor II gene defects are the most common of the inherited thrombophilic disorders, with a prevalence of 20% and 6%, respectively,² it would be appropriate to test for these defects first. Testing for homocysteinemia would come second, followed by antiphospholipid antibodies, although one must . . . [Full Text of this Article]

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ABSTRACT