Musiał, Jacek

Zawilska, Krystyna

Polish Archives of Internal Medicine

English

Jagiellonian Univeristy Repository

LETTER TO THE EDITOR Comment on “Venous thrombosis: who should be screened for thrombophilia in 2014?” 215of clotting factor deficiency, mainly FXII), and women with recurrent spontaneous pregnancy loss.3 The latest clinical guidelines of the Nation‑al Institute for Health and Care Excellence also recommend testing for antiphospholipid antibod‑ies: in patients who have had unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE; if withdrawal of anticoagulation treatment is planned); and in patients who have had unpro‑voked DVT or PE and have a first ‑degree relative with previous DVT or PE.4In addition, we would not lightly discard the option to treat positive (especially so called “triple positive”) patients indefinitely in the light of recent data showing that, in patients diag‑nosed with antiphospholipid syndrome during the 10 ‑year period, 36.5% of the fatal cases were related to severe thrombosis.5We hope this additional information will help readers of the Polish Archives of Internal Medicine decide whether thrombophilia testing may be of value for primary and secondary VTE prophylax‑is in their patients.Author names and affiliations Krystyna Zawilska, Jacek Musiał; members of the Working Group on Haemostasis of the Polish Society on Haemtolo‑gy and Transfusion Medicine (K.Z.: Poznan Uni‑versity of Medical Sciences, Center for Diagnosis and Therapy, INTERLAB, Poznań, Poland; J.M.: 2nd Department of Internal Medicine, Jagiello‑nian University Medical College, Kraków, Poland)Corresponding author Prof. Jacek Musiał, MD, PhD, II Katedra Chorób Wewnętrznych, Uni‑ wersytet Jagielloński, Collegium Medicum, ul. Skawińska 8, 31‑066 Kraków, phone: +48‑‑12‑430‑53‑14, fax: +48 ‑12 ‑430‑50‑66, e ‑mail: mmmusia@cyf ‑kr.edu.pl Conflict of interest The authors declare no con‑flict of interest.REfEREnCEs1 Kyrle PA. Venous thrombosis: who should be screened for thrombophilia in 2014? Pol Arch Med Wewn. 2014; 124: 65-69.2 De Stefano V, Rossi E. Testing for inherited thrombophilia and con-sequences for antithrombotic prophylaxis in patients with venous To the Editor We read the review article by Paul A. Kyrle with great interest.1 We fully agree with the author that systematic indiscriminate lab‑oratory thrombophilia screening in all patientswith the first unprovoked venous thromboem‑bolic episode (VTE) is unwarranted and shouldbe discouraged. However, there is still1 one im‑portant and unanswered question: who should bescreened for thrombophilia? We would all proba‑bly agree that owing to age dependency of VTE,elder patients should not be screened. However,those aged from 45 to 50 years (or even young‑er) with unprovoked episodes certainly requireour attention. At this point, some differencesregarding inherited and acquired thrombophil‑ia may be of issue.The utility of laboratory investigation for in‑herited thrombophilia in patients with VTE and their asymptomatic relatives has been largely de‑bated, leading to the production of several guide‑lines by scientific societies and various working groups. As the risk largely depends on the fam‑ily history of VTE, the identification of asymp‑tomatic carrier among relatives of the probands with VTE and thrombophilia could reduce cases of provoked VTE by offering them primary anti‑thrombotic prophylaxis during risk situations. In most guidelines, this is considered justified only for relatives of probands with a deficiency of nat‑ural anticoagulants or multiple abnormalities. Counselling asymptomatic female relatives of in‑dividuals with VTE and/or thrombophilia before planned conception or treatment with hormon‑al preparations should also be recommended de‑pending on the risk driven by the type of throm‑bophilia and the family history of VTE.2Acquired thrombophilia mainly involves test‑ing for antiphospholipid antibodies necessary to establish the diagnosis of antiphospholipid syn‑drome. Even if evidence on the risk of recurrent thrombosis in patients with antiphospholipid an‑tibodies is low or available data are of poor qual‑ity, we still believe the testing may be warrant‑ed. The tested group should include: younger pa‑tients (<50 years), patients with a systemic auto‑immune disease and any VTE episode in history, patients with accidentally found prolonged acti‑vated partial thromboplastin time (after exclusion LETTER TO THE EDITORComment on “Venous thrombosis: who should be screened for thrombophilia in 2014?”216thromboembolism and their relatives. A review of the Guidelines from Scien-tific Societies and Working Groups. Thromb Haemost. 2013; 110: 697-705.3 Pengo V, Tripodi A, Reber G, et al. Update of the guidelines for lupus anti-coagulant detection. J Thromb Haemost. 2009; 7: 1737-1740.4 Venous thromboembolic diseases: the management of venous thrombo-embolic diseases and the role of thrombophilia testing. NICE clinical guide-lines; issued: June 2012:CG144. http//guidance.nice.org.uk. Accessed Jan-uary 2014.5 Cerevera R, Serrano R, Pons- Estel GJ, et al Morbidity and mortal-ity in the antiphospholipid syndrome during a 10- year period: a multi-center prospective study of 1000 patients. Ann Rheum Dis. 2014. doi: 10.1136/annrheumdis -2013 -204 838.POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2014; 124 (4)

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