Current Indications for Thrombophilia Testing - A Modified Delphi Consensus Study in Switzerland.

Area of Science:

• Hematology
• Clinical Medicine
• Medical Diagnostics

Background:

• Thrombophilia, a condition increasing venous thromboembolism (VTE) risk, has inconsistent patient selection criteria for testing across guidelines.
• This variability highlights uncertainty in routine thrombophilia testing strategies.
• Establishing expert consensus is crucial for standardizing diagnostic approaches.

Purpose of the Study:

• To establish expert consensus on clinical indications for thrombophilia testing in Switzerland.
• To address the heterogeneity in current thrombophilia testing practices.
• To provide guidance for consistent and evidence-based diagnostic decisions.

Main Methods:

• A modified Delphi study involving 42 clinical experts managing VTE patients in Switzerland.
• Two rounds of surveys presenting clinical scenarios and statements on thrombophilia testing.
• Consensus defined as ≥70% agreement on a 7-point Likert scale (≥5).

Main Results:

• Consensus was achieved on 32 statements covering various clinical scenarios for thrombophilia testing.
• Key areas included unprovoked VTE, provoked VTE (hormone-associated), unusual site VTE, and pediatric VTE.
• Specific recommendations support testing in patients <60 with unprovoked/unusual site VTE and women with hormone-associated VTE.

Conclusions:

• The modified Delphi process successfully generated expert consensus on 32 thrombophilia testing indications.
• These consensus statements can guide clinical decision-making and promote consistent testing practices.
• The findings may inform future development of evidence-based guidelines for thrombophilia diagnostics.