Hypercoagulability

Abstract

The claim that Virchow attributed venous thrombosis to ‘hypercoagulability’ is refuted. Two uses of the word ‘hypercoagulability’ are distinguished: a general sense, which entails circular reasoning, and a specific sense, for which the synonym ‘thrombophilia’ is substituted. Three predictions of the hypothesis that ‘hypercoagulability causes DVT’ are identified. One of these is shown to be weakly corroborated by early studies on ‘experimental thrombi’. The others are evaluated through a review of the literature on hereditary and acquired thrombophilias and are shown not to be supported by the available evidence. The conclusion — that thrombophilias increase the likelihood of DVT but cannot be considered ‘causal’ — is followed by a critical discussion of the clinical value of laboratory tests for thrombotic tendencies, and the need for an alternative to the consensus model of DVT aetiology is re-emphasised.