Abstract
Background
There is scarce information on the management habits with regard to thrombophilia
testing in patients with venous thromboembolism (VTE).
Patients and Methods
RIETE is an ongoing registry of consecutive patients with symptomatic VTE. Aimed to
estimate the extent to which thrombophilia test ordering patterns are consistent with
the recommendations by a 2005 international consensus statement, we retrospectively
compared the clinical characteristics of all patients tested for thrombophilia and
those who were not tested.
Results
Of 21367 patients enrolled, 4494 (21%) were tested for thrombophilia: 1456 (32%) tested
positive, 3038 (68%) negative. The most common abnormalities were: Factor V Leiden
(N=376), antiphospholipid syndrome (N=289), and prothrombin G20210A (N=263). Overall, 12740 (60%) patients met one or more criteria of the consensus statement:
7894 (37%) had a first episode of idiopathic VTE; 4013 (19%) were aged <50 years; 133 (0.6%) were pregnant women; 758 (3.5%) were using estrogens; 3375 (16%)
had recurrent VTE. Of them, 3618 (28%) underwent thrombophilia tests, 34% of whom
tested positive. The percentage of patients testing positive was significantly higher
in those aged <50 years, with no differences between idiopathic or secondary, first episode or recurrent
VTE. Finally, 876 (10%) of the 8627 (40%) patients meeting no criteria were tested.
Of these, 208 (24%) tested positive.
Conclusions
Twenty-eight percent of patients meeting one or more criteria for thrombophilia testing,
and 10% of those with no criteria were actually tested. Thus, a substantial proportion
of thrombophilia ordering is not consistent with the recommendations made by the consensus
statement.
Keywords
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References
- Laboratory testing for heritable thrombophilia: Impact on clinical management of thrombotic disease.Br J Haematol. 2000; 109: 699-703
- Investigation and management of heritable thrombophilia.Br J Haematol. 2001; 114: 512-528
- Inherited risk factors for venous thrombosis.Hematology Am Soc Hematol Educ Program. 2005; 2005: 452-457
- Efficiency of systematic thrombophilia screening in idiopathic venous thrombosis: A prospective study in Internal Medicine.Clin Appl Thromb Hemost. 2005; 11: 243-251
- Screening for thrombophilia in high-risk situations: A meta-analysis and cost-effectiveness analysis.Br J Haematol. 2005; 131: 80-90
- Testing for thrombophilia: an evidence-based approach.Postgrad Med J. 2006; 82: 699-704
- Screening for thrombophilia in high-risk situations: Systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study.Health Technol Assess. 2006; 10: 1-110
- Thrombophilia: Common questions on laboratory assessment and management.Hematology Am Soc Hematol Educ Program. 2007; 2007: 127-135
- Is screening for thrombophilia cost-effective?.Curr Opin Hematol. 2007; 14: 500-503
- Thrombophilia and venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence.Int Angiol. 2005; 24: 1-26
- Venous Thromboembolism in Patients with Renal Insufficiency. Findings from the RIETE Registry.Am J Med. 2006; 119: 1073-1079
- Venous Thromboembolism in Very Elderly Patients: Findings from a Prospective Registry (RIETE).Haematologica. 2006; 91: 1046-1051
- Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: Findings from the RIETE registry.J Thromb Haemost. 2006; 4: 1950-1956
- Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep vein thrombosis.N Engl J Med. 1990; 323: 1512-1516
- Hereditary thrombophilia among 217 consecutive patients with thromboembolic disease in Jordan.Am J Hematol. 1993; 44: 95-100
- Incidence and clinical characteristics of hereditary disorders associated with venous thrombosis.Am J Hematol. 1991; 36: 249-254
- The risk of recurrent venous thromboembolism among heterozygous carriers of factor V Leiden or prothrombin G20210A mutation. A systematic review of prospective studies.Haematologica. 2007; 92: 1107-1114
- An evaluation of thrombophilia screening in an urban tertiary care medical center.Am J Clin Pathol. 2006; 126: 120-127
- Testing for hereditary thrombophilia: a retrospective analysis of testing referred to a national laboratory.BMC Clin Pathol. 2008 Apr 2; 8: 3
Article info
Publication history
Accepted:
November 23,
2008
Received in revised form:
November 10,
2008
Received:
July 30,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
