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Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 3, pp 403–403 | Cite as

Comment on “Do hospital doctors test for thrombophilia in patients with venous thromboembolism?”

  • Turgay Ulas
Letter to the Editor

Dear Editor,

I read with great interest the recent article by Samim et al. dealing with the limited and inefficient predictive value of factor V Leiden and the G20210A prothrombin mutation regarding the recurrent venous thromboembolism (VTE) for the subsequent patient management [1]. The authors have clearly and diligently performed their study; on this basis, I agree with the authors and aimed to add some points.

Connors indicated in her recent review that ordering thrombophilia tests is easy, determining whom to test and how to use the results is not. Although inherited and acquired thrombophilias are acknowledged to increase the risk of VTE, the majority of patients with VTE should not be tested for thrombophilia, and similarly some investigators arguing that these tests should never be performed, and data also showing that the results do not affect clinical decisions about the treatment of VTE. Because most guidelines advocate for long term anticoagulation for patients with unprovoked VTE [2, 3, 4, 5, 6]. Importantly, data show no significant differences in rates of recurrent VTE between patients with and those without thrombophilia or between patients who undergo testing for inherited thrombophilia and those who do not. On the other hand, the significance of either positive or negative test results is often misinterpreted in clinical practice. Patients with positive results are frequently overtreated and kept on anticoagulant therapy indefinitely, even those with a provoked VTE and a low risk of recurrence, because of the perception that such patients have a significantly increased risk of recurrence [2, 7, 8].

As a supportive data shown by Samim et al. in their study that the thrombophilia status including FV Leiden and/or prothrombin G20210A mutation did not impact to the initial management of VTE [1]. We hope that the above-mentioned items might add to the value of the article by Samim et al.

References

  1. 1.
    Samim D, Marques-Vidal P, Alberio L, Waeber G, Méan M (2018) Do hospital doctors test for thrombophilia in patients with venous thromboembolism? J Thromb Thrombolysis.  https://doi.org/10.1007/s11239-018-1702-6 PubMedCrossRefGoogle Scholar
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    Connors JM (2017) Thrombophilia testing and venous thrombosis. N Engl J Med 377(12):1177–1187CrossRefPubMedGoogle Scholar
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    Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149(2):315–352CrossRefPubMedGoogle Scholar
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    Favaloro EJ, McDonald D, Lippi G (2009) Laboratory investigation of thrombophilia: the good, the bad, and the ugly. Semin Thromb Hemost 35(7):695–710CrossRefPubMedGoogle Scholar
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    National Clinical Guideline Centre (UK) (2012) Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. Royal College of Physicians (UK), London. http://www.ncbi.nlm.nih.gov/books/NBK132796/. Accessed 25 July 2018
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    Ulas T, Dal MS (2018) Should we screen hereditary thrombophilia testing in patients with provoked/unprovoked venous thromboembolism? Int J Cardiol.  https://doi.org/10.1016/j.ijcard.2018.05.108 PubMedCrossRefGoogle Scholar
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    Coppens M, Reijnders JH, Middeldorp S, Doggen CJ, Rosendaal FR (2008) Testing for inherited thrombophilia does not reduce the recurrence of venous thrombosis. J Thromb Haemost 6(9):1474–1477CrossRefPubMedGoogle Scholar
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    Couturaud F, Leroyer C, Tromeur C, Julian JA, Kahn SR, Ginsberg JS, Wells PS, Douketis JD, Mottier D, Kearon C (2014) Factors that predict thrombosis in relatives of patients with venous thromboembolism. Blood 124(13):2124–2130CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Hematology, Department of Internal Medicine, Near East University Hospital, School of MedicineNear East UniversityNicosiaCyprus

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