Laboratory thrombophilia screening: essentials for hematologists

Venous thromboembolism (VTE) is a chronic disease which tends to recur, in particular in patients with a first unprovoked VTE. Recurrence can be prevented by anticoagulants but at the price of bleeding. Identification of patients at high recurrence risk is therefore warranted. One such attempt consists of the routine determination of risk factors of VTE in the laboratory. However, laboratory thrombophilia screening has failed for the following reasons: it consists of measurement of risk factors for a first VTE rather than a second event; a parge proportion of patients with negative thrombophilia screening suffer from recurrence; studies showing a beneficial effect of thrombophilia screening do not exist; thrombophilia screening may confer emotional stress and anxiety. Therefore, patients with VTE should not be routinely screened for laboratory thrombophilia with the intention to optimize the duration of secondary thromboprophylaxis or to identify asymptomatic relatives who may harbor the same defect and may benefit from individual thromboprophylaxis.