From the Research
For individuals with a family history of venous thromboembolism, routine screening for thrombophilia is not recommended unless they have had a VTE event or are facing high-risk situations, as stated in the most recent and highest quality study 1. When considering screening and prophylaxis, several factors come into play, including the type of thrombophilia, family history, and individual risk factors.
- Genetic testing for thrombophilia may be considered, particularly for factor V Leiden mutation, prothrombin gene mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency.
- Prophylaxis is typically not prescribed based solely on family history but is warranted during high-risk periods such as surgery, prolonged immobility, pregnancy, or postpartum.
- In these situations, prophylactic anticoagulation with low molecular weight heparin (such as enoxaparin 40mg subcutaneously once daily) or unfractionated heparin (5,000 units subcutaneously every 8-12 hours) may be prescribed, as suggested by 1.
- For pregnant women with strong family histories, prophylactic enoxaparin may be continued for 6 weeks postpartum. Non-pharmacological measures are also important, including:
- Early mobilization after surgery
- Compression stockings
- Adequate hydration
- Avoiding prolonged immobility during travel These recommendations aim to balance the risk of thrombosis against the bleeding risks associated with anticoagulation therapy, as thrombophilia increases clot formation risk due to an imbalance in the coagulation cascade, as noted in 2.