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Hypercoagulable state testing and malignancy screening following venous thromboembolic events.
Steven R Deitcher1, Marcelo P V Gomes
1Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. deitchs@ccf.org
Vascular Medicine (London, England)
|July 18, 2003
Summary
Widespread hypercoagulable state testing reveals abnormalities in over half of venous thromboembolic event (VTE) patients, but often lacks clinical impact. Focus testing on guiding treatment, not for general knowledge.
Area of Science:
- Hematology
- Oncology
- Clinical Pathology
Background:
- Increased interest in hypercoagulability has led to widespread laboratory testing for acquired and inherited states.
- Testing identifies abnormalities in over 50% of patients with initial venous thromboembolic events (VTE).
- However, the clinical management impact of these findings is often minimal for most patients.
Purpose of the Study:
- To evaluate the clinical utility and cost-effectiveness of hypercoagulable state testing in patients with VTE.
- To determine appropriate indications for laboratory screening and cancer screening following VTE.
- To advocate for a shift in focus towards VTE prophylaxis and treatment over extensive, potentially low-value testing.
Main Methods:
- Review of current practices in hypercoagulable state testing.
- Analysis of the impact of test results on patient management decisions, including anticoagulation and family planning.
- Evaluation of the role and effectiveness of cancer screening in VTE patients.
Main Results:
- Hypercoagulable state testing reveals abnormalities in over 50% of VTE patients but rarely impacts management.
- Testing is most valuable when results directly influence anticoagulant choice, intensity, monitoring, or duration.
- Age- and gender-specific cancer screening is crucial, particularly in older individuals or those with idiopathic VTE without inherited hypercoagulable states.
Conclusions:
- Laboratory screening for hypercoagulable states should be reserved for specific clinical scenarios where results guide therapy.
- Testing solely for informational purposes ('just to know') is not cost-effective or clinically appropriate.
- Physicians should prioritize VTE prophylaxis and treatment, and judicious cancer screening, over extensive, potentially low-yield diagnostic testing.