Thrombophilia primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2] Jaspinder Kaur, MBBS[3]

Overview

Thromboprophylaxis with anticoagulation may be recommended for primary prevention of acute thrombosis in high risk acquired and inherited thrombophilias.

Primary Prevention

• Thrombosis Prevention:
  • There is no evidence to support the long-term pharmacological primary thromboprophylaxis of asymptomatic family members found to have a thrombophilic genotype.
  • Additionally, patients who experience a thrombotic event towards the end of their period of anticoagulant treatment course should be counseled about the signs and symptoms of thromboembolism and made aware about the requirement to seek an early medical attention on suspicion of a recurrence.
  • Moreover, they should be advised to mention their history of VTE to their physicians so that appropriate decisions about short-term thromboprophylaxis at times of increased thrombotic risk can be made.
  • Hence, all patients with a past history of VTE with or without evidence of a thrombophilic defect merit consideration for short-term thromboprophylaxis to cover periods of increased thrombotic risk such as surgery, trauma, plaster casts or immobilization.

Table 1: Enlist the indications for thromboprophylaxis with anticoagulation
Indications for thromboprophylaxis
Antithrombin deficiency Homozygous or compound heterozygous mutations for the underlying thrombophilias Multiple inherited thrombophilias Family history of thrombosis at a young age Post orthopedic surgery Post abdominal or pelvic surgery for gynecologic malignancies