Thrombophilias in adolescents: the past, present and future

In the past 10 years, clinicians have become more suspect regarding thromboembolic events and potential thrombosis in children at risk. Although adolescents are not typically considered to be a high-risk group, they are the main seekers of contraception in our society today, thereby placing them at some risk due to exogenous estrogen administration.

Certain thrombophilic states increase the risk of thromboembolism significantly. Because estrogen-containing hormonal contraceptives also increase the risk of thrombosis, inherited thrombophilias are a contraindication to the use of these contraceptives. Current guidelines support laboratory screening for inherited and acquired thrombophilias when personal history of deep venous thrombosis exists, unexplained spontaneous thrombosis occurs, recurrent thrombosis arises, there is a family history of thrombosis, or thrombosis in unusual sites, such as central nervous system, abdominal veins or upper limbs. Prophylactic anticoagulation is not necessary in the setting of certain thrombophilias; however, consultation with a hematologist may be helpful when making decisions on acute and long-term management of these patients.

Although some thrombophilic conditions are a contraindication to combined hormonal contraception, not all thrombophilias maintain the same level of risk. Routine history-taking to assess the risk of an inherited thrombophilia on the basis of family history is important prior to prescribing oral contraceptives and should be documented in a patient's chart. Laboratory screening is recommended in specific risk scenarios; however, routine screening is not presently recommended prior to oral contraceptive initiation.