Do we need more guidance on thrombophilia testing? Challenges and special considerations.

Thrombophilia testing (TT) is a laboratory procedure designed to detect the risk factors involved in the pathogenesis of vascular occlusions. The role of TT is controversial also because it has a limited impact on the choice and duration of antithrombotic treatments. We reviewed, by examining MEDLINE up to October 2023. Accepted and not accepted thrombophilia markers are discussed along with the appropriateness or not of prescribing TT in several conditions such as: provoked and unprovoked venous thromboembolism (VTE), women who are planning a pregnancy whose relatives had VTE or have a hereditary thrombophilia, before assumption of estro-progestins, after multiple pregnant loss, arterial thrombosis, retinal vein occlusion and splanchnic vein thrombosis. TT is not essential in the management of VTE but it may be useful for limiting adverse events in case of thrombophilia. We expose our criticism on items afforded by other guidelines by presenting our opinion based on both the scientific evidence and clinical practise. We also deal with common mistakes in prescribing and interpretations of TT hoping to purpose an educational approach on this topic. Finally, we emphasize the creation of the expert in hemostasis and thrombosis who should be present in every hospital.