Suggested thrombophilia testing in hormone-related VTE: who, why, when, what and how to test?
| Who . | Why . | When . | What . | Howc . | ||
|---|---|---|---|---|---|---|
| VTE associated with combined oral contraceptives | Strategyb to guide the decision to stop or continue anticoagulant therapy after primary treatment phase; indefinite anticoagulant treatment for patients with thrombophilia is suggested. | Only test when, after shared decision-making, the result impacts the decision to stop or continue anticoagulation therapy. | Thrombophilia panel: • factor V Leiden mutation • prothrombin G20210A mutation • PC deficiency • PS deficiency • AT deficiency • antiphospholipid antibodies (LAC, anti-ß2- glycoprotein-I IgG and IgM antibodies, anticardiolipin IgG and IgM antibodies) | If on DOAC: • can influence LAC/PC/PSd/AT results • briefly interrupt or temporally switch to LMWH and test at anticoagulant trough | If on VKA: • can influence LAC/PS/PC results • switch to LMWH and test at anticoagulant trough | If on LMWH: test at anticoagulant trough |
| VTE provoked by pregnancy or 3-month postpartum period | ||||||
| VTE associated with assisted reproductive technologya | ||||||
| VTE associated with hormone replacement therapya | ||||||
| VTE associated with gender-affirming therapya | ||||||
| Who . | Why . | When . | What . | Howc . | ||
|---|---|---|---|---|---|---|
| VTE associated with combined oral contraceptives | Strategyb to guide the decision to stop or continue anticoagulant therapy after primary treatment phase; indefinite anticoagulant treatment for patients with thrombophilia is suggested. | Only test when, after shared decision-making, the result impacts the decision to stop or continue anticoagulation therapy. | Thrombophilia panel: • factor V Leiden mutation • prothrombin G20210A mutation • PC deficiency • PS deficiency • AT deficiency • antiphospholipid antibodies (LAC, anti-ß2- glycoprotein-I IgG and IgM antibodies, anticardiolipin IgG and IgM antibodies) | If on DOAC: • can influence LAC/PC/PSd/AT results • briefly interrupt or temporally switch to LMWH and test at anticoagulant trough | If on VKA: • can influence LAC/PS/PC results • switch to LMWH and test at anticoagulant trough | If on LMWH: test at anticoagulant trough |
| VTE provoked by pregnancy or 3-month postpartum period | ||||||
| VTE associated with assisted reproductive technologya | ||||||
| VTE associated with hormone replacement therapya | ||||||
| VTE associated with gender-affirming therapya | ||||||
Defined as a nonsurgical major transient risk factor.
In patients with VTE related to major surgery (who have a low VTE recurrence risk) or patients with unprovoked VTE (who have a high VTE recurrence risk), this strategy is not suggested as a thrombophilia testing strategy does not affect the decision to stop or continue anticoagulation therapy.
Applies to therapeutic-dosed anticoagulation; see also Table 5 and Favaloro et al41 for practical points.
DOAC use may influence PS activity levels; PS antigen measurements are not affected.
LAC, lupus anticoagulant.
Based on the ASH 2023 guidelines for management of venous thromboembolism: thrombophilia testing, adapted with permission from Middeldorp et al.27