The skin and hypercoagulable states

J Am Acad Dermatol. 2013 Sep;69(3):450-62. doi: 10.1016/j.jaad.2013.01.043. Epub 2013 Apr 9.


Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder. This review will focus on the basic science of hemostasis, the evaluation of HS, the skin manifestations associated with hypercoagulability, and the use of antiplatelet and anticoagulant therapy in dermatology.

Keywords: APC; APLA; APLS; CVU; DIC; DVT; HIT; HS; LMWH; LR; LV; PE; PF; SVT; TF; TTP; VTE; activated protein C; anetoderma; antiphospholipid antibody; antiphospholipid antibody syndrome; chronic venous ulcer; chronic venous ulceration; deep venous thrombosis; disseminated intravascular coagulation; hemostasis; heparin-induced thrombocytopenia; hypercoagulable states; livedo reticularis; livedo vasculopathy; low-molecular-weight heparin; pulmonary embolism; purpura; purpura fulminans; superficial venous thrombosis; thrombosis; thrombotic thrombocytopenic purpura; tissue factor; venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Anetoderma / complications
  • Anticoagulants / therapeutic use
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / drug therapy
  • Calciphylaxis / complications
  • Hemostasis
  • Heparin / adverse effects
  • Humans
  • Livedo Reticularis / complications
  • Necrosis / chemically induced
  • Platelet Aggregation Inhibitors / therapeutic use
  • Purpura / complications
  • Skin / pathology*
  • Skin Diseases / complications*
  • Skin Diseases / drug therapy
  • Thrombophilia / complications
  • Thrombophilia / diagnosis*
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology*
  • Varicose Ulcer / complications
  • Varicose Ulcer / drug therapy
  • Venous Thrombosis / complications
  • Venous Thrombosis / drug therapy
  • Warfarin / adverse effects


  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Warfarin
  • Heparin