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Thrombophilia Screening Eligibility Algorithm

Choosing Wisely: Thrombophilia testing is high-cost and prone to interference. It should only be performed if it will change clinical management (e.g., stopping prophylaxis).

1. Indications for Workup

2. Contraindications / Exclusions

Screening Eligibility Status

SCREENING NOT INDICATED

Rationale

No high-yield indications for a hereditary thrombophilia workup.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

When to Screen

First unprovoked Venous Thromboembolism (VTE) at a young age (typically < 45-50 years).

Strong family history of VTE (at least one first-degree relative with unprovoked VTE before age 50).

Recurrent unprovoked VTE.

VTE in unusual vascular beds (e.g., cerebral venous sinus, mesenteric, portal veins).

Skin necrosis induced by vitamin K antagonists (suggestive of Protein C deficiency).

The 'Golden Rule' of Timing

Do NOT screen during the acute phase of a VTE or while the patient is on therapeutic anticoagulation (Warfarin, Heparin, or DOACs). Factors like Protein S and Antithrombin are consumed in the acute clot, leading to false positives.

Last Comprehensive Review: 2026

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