title: Thrombophilia Screening.
abstract: Although controversial, screening for thrombophilia has become common. Testing for antiphospholipid antibodies is indicated in order to guide treatment decisions if there is clinical suspicion for antiphospholipid syndrome. The utility of identifying other thrombophilias in symptomatic venous thromboembolism (VTE) is questionable, as the risk of recurrence does not appear to be increased by an appreciable degree with the most common disorders (heterozygosity for factor V Leiden or prothrombin mutation). Although recurrence appears to be increased in those with homozygous or multiple abnormalities and potentially deficiencies in natural anticoagulants, screening to detect these conditions is difficult to justify based on their rarity. The American College of Chest Physicians' current guidelines note the increased risk of recurrence with idiopathic, proximal events regardless of thrombophilia status. They suggest duration of anticoagulation therapy be based on location and provoking factors rather than whether or not the individual has a thrombophilia. Because routine prophylaxis in asymptomatic individuals with thrombophilia is not recommended, screening of asymptomatic family members is difficult to justify. Screening prior to prescribing combination oral contraceptives is not cost effective, may result in unwanted pregnancies, and may have little effect on the overall rate of VTE.
authors.affiliation: Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA Midtown Medical Center, Columbus, GA, USA hornslb@auburn.edu.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Hornsby
authors.affiliation: Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Armstrong
authors.affiliation: Ambulatory Pharmacy Services, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Bellone
authors.affiliation: Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA Department of Family Medicine, University of South Alabama, Mobile, AL, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Treadway
authors.affiliation: Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA Family Medicine-Huntsville Campus, University of Alabama School of Medicine, Huntsville, AL, USA.
authors.forename: Haley M
authors.initials: HM
authors.lastname: Phillippe
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000032:analysis; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017410:Practice Guidelines as Topic; D012008:Recurrence; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants
keywords: antiphospholipid antibodies; antithrombin deficiency; factor V Leiden; inherited thrombophilia; protein C deficiency; protein S deficiency; prothrombin mutation; screening; thrombophilia