[Thrombophilic disorders in venous thromboembolism. The clinical perspective]

Treatment of venous thromboembolism should consider the influence of thrombophilic disorders on the risk of recurrence. Diagnostic tests should be guided by their expected relevance to therapy. A competent and straightforward clinical approach to venous thromboembolism requires knowledge of the current data regarding stratification of risk of recurrence in thrombophilic patients.

Focusing on clinical management, the current literature on thrombophilia is analyzed. Recommendations are given taking into account the risk of first and recurrent thromboembolism, the bleeding risk under anticoagulation, and validated therapy strategies. A rational diagnostic approach in the light of potential therapies is suggested.

The recurrence risk after triggered venous thromboembolism is low, and anticoagulation does not need to be extended beyond 6 months. Idiopathic or thromboembolism in unusual locations is associated with a higher recurrence risk since underlying thrombophilia is more common in these patients. These cases merit laboratory screening for thrombophilic factors (whose relevance is discussed), and extended anticoagulation is indicated (1 year; in severe thrombophilia several years). In recurrent venous thromboembolism anticoagulation is ideally continued for 4 years, or longer in the absence of complications.