An evaluation of thrombophilia screening in an urban tertiary care medical center: A "real world" experience.

To evaluate the utilization of thrombophilia screening at a large urban academic tertiary care center, we retrospectively examined the indications, appropriateness, and results of 200 consecutive thrombophilia panels. Of the panels, 103 (51.5%) were ordered for venous thromboembolism; 124 (62.0%) were ordered during acute thrombotic episodes, and at least 40 (20.0%) had abnormal protein C and S results, of which 25 (63%) were attributable to anticoagulation and the remainder to pregnancy. Of the 200 panels, 46 (23.0%) had a significant abnormality; the most common abnormal result was a lupus anticoagulant, occurring in 23 cases (11.3%). Thrombophilia screening seems to be overutilized in our population, especially considering that the majority of tests are ordered during suboptimal conditions, eg, acute thrombosis, pregnancy, or anticoagulation. At present, outside the research setting, thrombophilia panels should be reserved for special circumstances, targeted to factors for which there would be a specific clinical impact, and performed in the absence of confounding clinical variables.