Impact of thrombophilia screening on venous thromboembolism management practices

Garcia‐Horton, Alejandro; Kovacs, Michael J.; Abdulrehman, Jameel; Taylor, Jay E.; Sharma, Shobha; Lazo‐Langner, Alejandro

doi:10.1016/j.thromres.2016.11.023

Cited by 20 publications

(18 citation statements)

References 25 publications

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“…Although these disorders are found in~5-10% of patients with a first VTE incident, they may not be independent risk factors for recurrent thrombosis. After adjustment for age, sex, and anticoagulant use, these thrombophilia disorders are only associated with a relatively low (~1.5-fold increase) risk of VTE recurrence compared to their non-thrombophilia patient counterparts [36][37][38][39]. Observations from recent case reports and case series on efficacy of DOACs in patients with FVL or PT G20210A mutation are mostly in line with our favorable subgroup analysis results, supporting the use of DOACs in these low-risk thrombophilias (Table S5) [40][41][42][43][44][45][46][47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Elsebaie

Langston

et al. 2019

Journal of Thrombosis and Haemostasis

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We investigated direct oral anticoagulant (DOAC) use in venous thromboembolism and thrombophilia. A comprehensive search identified 10 studies, 8 of which were included in a meta‐analysis. DOACs were overall safe and effective in patients with venous thromboembolism and thrombophilia. Efficacy/safety of DOACs was maintained in low‐risk antiphospholipid syndrome patient subgroup. Summary BackgroundDirect oral anticoagulants (DOACs) are increasingly used in acute and long‐term treatment of venous thromboembolism (VTE). However, their role in management of thrombophilia‐associated VTE is controversial. MethodsThrough a comprehensive search on MEDLINE, Cochrane Library, and Clinicaltrials.gov, we identified 10 eligible studies, 8 of which reporting data on 1994 thrombophilia patients were included in a random‐effects meta‐analysis. Eligible studies were phase 2 to 3 randomized controlled trials comparing DOACs to vitamin K antagonists (VKAs) in patients with VTE, including those with thrombophilia. ResultsOf eight studies included in meta‐analysis, four evaluated rivaroxaban, three dabigatran, and one edoxaban. No results could be obtained on apixaban use. The rates of VTE recurrence (RR, 0.70; 95% CI, 0.34–1.44; I2 = 0%) and major/clinically relevant non‐major bleeding events (RR, 0.92; 95% CI, 0.62–1.36; I2 = 23%) were similar between thrombophilia patients treated with DOACs compared to VKAs. Results were comparable to findings in patients without known thrombophilia: RR, 1.02; 95% CI, 0.80–1.30; I2 = 46% for VTE recurrence and RR, 0.72; 95% CI, 0.57–0.90; I2 = 84% for major/clinically relevant non‐major bleeding events. ConclusionsRates of VTE recurrence and bleeding events were both low and comparable in patients with various thrombophilias receiving either treatment, suggesting that DOACs are an appropriate treatment option in this population. Due to limited data, it is unclear whether these findings apply to specific subgroups such as high‐risk antiphospholipid syndrome, uncommon thrombophilias, or the use of apixaban.

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Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Elsebaie

Langston

et al. 2019

Journal of Thrombosis and Haemostasis

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“…A 2017 study illustrated that when using a clinical decision rule (Clinical Decision Rule Validation Study to Predict Low Recurrent Risk in Patients With Unprovoked Venous Thromboembolism [REVERSE criteria]) in patients with a first, unprovoked VTE, routine thrombophilia screening added little to determining the need for prolonged anticoagulation. 12 These findings support the limited clinical utility of current test ordering practices for the prediction and management of recurrent venous thrombosis.…”

Section: Discussionmentioning

confidence: 72%

Magnitude of Potentially Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting

Mou

Kwang

Hom

et al. 2017

Journal of Hospital Medicine

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Laboratory costs of thrombophilia testing exceed an estimated $650 million (in US dollars) annually. Quantifying the prevalence and financial impact of potentially inappropriate testing in the inpatient hospital setting represents an integral component of the effort to reduce healthcare expenditures. We conducted a retrospective analysis of our electronic medical record to evaluate 2 years' worth of inpatient thrombophilia testing measured against preformulated appropriateness criteria. Cost data were obtained from the Centers for Medicare and Medicaid Services 2016 Clinical Laboratory Fee Schedule. Of the 1817 orders analyzed, 777 (42.7%) were potentially inappropriate, with an associated cost of $40,422. The tests most frequently inappropriately ordered were Factor V Leiden, prothrombin gene mutation, protein C and S activity levels, antithrombin activity levels, and the lupus anticoagulant. Potentially inappropriate thrombophilia testing is common and costly. These data demonstrate a need for institution-wide changes in order to reduce unnecessary expenditures and improve patient care.

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“…Concerning our cohort, the testing did not have the consequences for the duration of anticoagulation therapy in most of the cases [22,23]. However, at least 10%-11% of females from our cohort were candidates for prolonged anticoagulation therapy (female with F V Leiden mutation in homozygous form, female with antithrombin, protein C and S deficiency, APS, combined thrombophilia) and also this finding can have the impact on management of pregnancy and puerperium in the future.…”

Section: Discussionmentioning

confidence: 76%

Thrombophilia Work-up in Females with Venous Thromboembolism in Association with Oral Contraceptive Use: Results, Strategy and Clinical Application of Testing

Dulíček¹,

Sadílek²,

Beránek³

et al. 2017

J Hematol Thrombo Dis

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Impact of thrombophilia screening on venous thromboembolism management practices

Cited by 20 publications

References 25 publications

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta‐analysis

Magnitude of Potentially Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting

Thrombophilia Work-up in Females with Venous Thromboembolism in Association with Oral Contraceptive Use: Results, Strategy and Clinical Application of Testing

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