Jornal de Hematologia e Doenças Tromboembólicas
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Thrombophilia Work-up in Females with Venous Thromboembolism in Association with Oral Contraceptive Use: Results, Strategy and Clinical Application of Testing

Dulicek P, Sadilek P, Beranek M, Ivanova E and Hirmerova J

Background: Oral contraceptive use is one of the most common causes of venous thromboembolism in females in a reproductive age. The usefulness of thrombophilia work-up in this scenario has been discussed in the last years especially in the term of financial cost and clinical implication. In the case of testing, it is necessary to keep appropriate timing and conditions for every assay. Methods: We analyzed thrombophilia work-up in a large cohort of 700 females with venous thrombosis in association with combined contraceptive pills use. We focused on laboratory thrombophilia work-up in the term of an appropriate strategy of testing, the influence of oral contraceptives use, presence of acute thrombosis and type of anticoagulation therapy.
Results: We found high frequency of inherited thrombophilia and antiphospholipid syndrome in our study group (45%). F V Leiden was absolutely the most frequent (30%). The frequency of inherited thrombophilia and antiphospholipid syndrome in the subgroup of females with spontaneous VTE reached significant statistically difference (p<0.0001) in comparison with the subgroup with VTE in risk situation. Based on current approach to testing, we assume the result had clinical impact only in 10%-11% of cases. So that nowadays we prefer personalized and individual approach to testing.
Conclusion: Thrombophilia work-up involves many tests based on different principles so that the perfect knowledge, what, when and how is inevitable for correct results and clinical interpretation. In spite of a high frequency of thrombophilia, the testing is recommended selectively only when the result has clinical consequence.
Summary: Oral contraceptive use is one of the most common causes of venous thromboembolism in females in a reproductive age. We analyzed thrombophilia work-up in a large cohort of 700 females with thrombosis in association with combined contraceptive pills use. In this article, we focused on laboratory thrombophilia work-up in the term of an appropriate strategy of testing and the discussion of usefulness of this testing generally. Thrombophilia work-up involves many tests based on different principles. So that the perfect knowledge, what, when and how is inevitable for correct results and clinical interpretation. We recommend testing only in cases, when the result has impact on clinical management.