Should surgical patients be screened for thrombophilia?

Genetic abnormalities that predispose a patient to venous thromboembolism (VTE) can now be identified. These genetic abnormalities include resistance to activated protein C and deficiencies of antithrombin, protein C, or protein S. Because the risk of VTE in surgical patients is well documented, the question naturally arises as to whether screening for genetic predisposition to VTE is indicated. This paper provides an outline of the need to prevent VTE in surgical patients and a brief review of current criteria for prophylaxis. This paper also provides an evaluation of the possible role for thrombophilia screening for surgical patients, based on perspectives gained from prophylaxis. At present, a small but well-defined group of patients, especially those with idiopathic VTE or a strong family history of the disease, should be screened for thrombophilia. Results from subsequent clinical trials may indicate the need to expand the role of thrombophilia screening.