PB0949 - Variability in thrombophilia testing in large international physician survey

Background: Thrombophilia testing is indicated when the presence of hypercoagulability influences management. Evidence-based recommendations for testing are available for certain clinical situations however, guidance is absent or lacks support from robust clinical study data in numerous clinical situations.

Aims: To determine worldwide thrombophilia testing practices of thrombosis physicians across a range of clinical situations for which clinical guidelines are lacking or are based on low grade clinical evidence.

Methods: A SurveyMonkey® questionnaire was distributed to 60 international thrombosis physicians, posted on the ISTH website and on the Twitter feed of one of the authors (BH).
Survey questions included respondents' characteristics and geographic location. Clinical scenarios covered unusual site venous thrombosis, arterial thrombosis, obstetric complications and family screening. Respondents indicated whether no testing, hereditary thrombophilia testing, antiphospholipid antibody testing or both should be performed. Consensus levels were predefined.

Results: Of 227 respondents, 155 consultant physicians whose main clinical interest is thrombosis and hemostasis were included in this analysis. 97% of respondents do not perform any testing after venous thromboembolism (VTE) with major provocation while 73.6% test after an unprovoked event, establishing reasonable guideline adherence. No consensus was found regarding contraceptive-related VTE, unusual site thrombosis, intra uterine growth restriction, preeclampsia or preceding contraceptive use with a familial thrombosis history. Moderate consensus existed for ischemic stroke, recurrent pregnancy loss, placental abruption and implantation failure. Consensus existed regarding no role for screening prior to oral contraception in patients with migraine and transdermal hormone replacement following cancer-associated thrombosis. Physicians in the Middle East were more likely to perform testing than those in the United States, Europe, Canada and the United Kingdom.

Conclusion(s): Marked variability in thrombophilia testing exists among thrombosis experts across a broad range of clinical entities, despite the availability of published guidelines. Clinical studies should be encouraged in areas where knowledge gaps exist.