What are the limitations of the thrombophilia screening?

While the thrombophilia screening is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the thrombophilia screening to ensure safe bedside use and optimal diagnostic accuracy.

How does the thrombophilia screening compare to other Hematology scores?

The thrombophilia screening is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the thrombophilia screening free to use?

Yes. OpiCalc provides the thrombophilia screening completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

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Thrombophilia Screening Eligibility Algorithm

Choosing Wisely: Thrombophilia testing is high-cost and prone to interference. It should only be performed if it will change clinical management (e.g., stopping prophylaxis).

1. Indications for Workup

2. Contraindications / Exclusions

Screening Eligibility Status

SCREENING NOT INDICATED

Rationale

No high-yield indications for a hereditary thrombophilia workup.

Guidelines & Evidence

Clinical Details

Section 1

When to Use

When to Screen

First unprovoked Venous Thromboembolism (VTE) at a young age (typically < 45-50 years).

Strong family history of VTE (at least one first-degree relative with unprovoked VTE before age 50).

Recurrent unprovoked VTE.

VTE in unusual vascular beds (e.g., cerebral venous sinus, mesenteric, portal veins).

Skin necrosis induced by vitamin K antagonists (suggestive of Protein C deficiency).

The 'Golden Rule' of Timing

Do NOT screen during the acute phase of a VTE or while the patient is on therapeutic anticoagulation (Warfarin, Heparin, or DOACs). Factors like Protein S and Antithrombin are consumed in the acute clot, leading to false positives.

Section 2

Formula & Logic

Exclusion Criteria (Do NOT test if present)

Provoked VTE (e.g., after major surgery, trauma, or prolonged immobilization).

Currently on Warfarin (interferes with Protein C/S results).

Currently on DOACs (Apixaban, Rivaroxaban, etc., interfere with Lupus Anticoagulant and functional assays).

Patient with unprovoked VTE who is already committed to lifelong anticoagulation.

Section 3

Pearls/Pitfalls

Will it Change Management?

This is the fundamental question. Since most patients with unprovoked VTE require long-term anticoagulation anyway, knowing a thrombophilic factor exists rarely changes the treatment plan. The main indication is for counseling family members (especially females about OCP/pregnancy risk).

Wait Time

Standard practice is to wait at least 2 weeks after stopping all anticoagulation (and at least 3-6 months after the acute event) before performing a formal thrombophilia screen.

Section 4

Evidence Appraisal

Primary Strategy

Guidance for the evaluation and treatment of hereditary and acquired thrombophilia.

Stevens SM et al. • Journal of Thrombosis and Thrombolysis. 2016;41(1):154-164.

View Source

Inherited thrombophilia: a double-edged sword.

Middeldorp S. • Hematology Am Soc Hematol Educ Program. 2016;2016(1):1-9.

View Source

Section 5

Literature

Consensus

Reflects the ASH (American Society of Hematology) Choosing Wisely recommendations to avoid unnecessary and misleading testing.

Last Comprehensive Review: 2026

Guidelines & Evidence

Clinical Details

Section 1

When to Use

When to Screen

First unprovoked Venous Thromboembolism (VTE) at a young age (typically < 45-50 years).

Strong family history of VTE (at least one first-degree relative with unprovoked VTE before age 50).

Recurrent unprovoked VTE.

VTE in unusual vascular beds (e.g., cerebral venous sinus, mesenteric, portal veins).

Skin necrosis induced by vitamin K antagonists (suggestive of Protein C deficiency).

The 'Golden Rule' of Timing

Section 2

Formula & Logic

Exclusion Criteria (Do NOT test if present)

Provoked VTE (e.g., after major surgery, trauma, or prolonged immobilization).

Currently on Warfarin (interferes with Protein C/S results).

Currently on DOACs (Apixaban, Rivaroxaban, etc., interfere with Lupus Anticoagulant and functional assays).

Patient with unprovoked VTE who is already committed to lifelong anticoagulation.

Section 3

Pearls/Pitfalls

Will it Change Management?

Wait Time

Standard practice is to wait at least 2 weeks after stopping all anticoagulation (and at least 3-6 months after the acute event) before performing a formal thrombophilia screen.

Section 4

Evidence Appraisal

Primary Strategy

Guidance for the evaluation and treatment of hereditary and acquired thrombophilia.

Stevens SM et al. • Journal of Thrombosis and Thrombolysis. 2016;41(1):154-164.

View Source

Inherited thrombophilia: a double-edged sword.

Middeldorp S. • Hematology Am Soc Hematol Educ Program. 2016;2016(1):1-9.

View Source

Section 5

Literature

Consensus

Reflects the ASH (American Society of Hematology) Choosing Wisely recommendations to avoid unnecessary and misleading testing.

Last Comprehensive Review: 2026

Related Hematology Tools

PERC Rule

YEARS Algorithm

Age-adjusted D-dimer Threshold

sPESI

HEP Score

HERDOO2 Rule

Vienna Prediction Model

Padua RAM

Antiphospholipid Syndrome Classification

GAPSS

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Thrombophilia Screening Eligibility Algorithm

Choosing Wisely: Thrombophilia testing is high-cost and prone to interference. It should only be performed if it will change clinical management (e.g., stopping prophylaxis).

1. Indications for Workup

2. Contraindications / Exclusions

Screening Eligibility Status

SCREENING NOT INDICATED

Rationale

No high-yield indications for a hereditary thrombophilia workup.

Guidelines & Evidence

Clinical Details

Section 1

When to Use

When to Screen

First unprovoked Venous Thromboembolism (VTE) at a young age (typically < 45-50 years).

Strong family history of VTE (at least one first-degree relative with unprovoked VTE before age 50).

Recurrent unprovoked VTE.

VTE in unusual vascular beds (e.g., cerebral venous sinus, mesenteric, portal veins).

Skin necrosis induced by vitamin K antagonists (suggestive of Protein C deficiency).

The 'Golden Rule' of Timing

Section 2

Formula & Logic

Exclusion Criteria (Do NOT test if present)

Provoked VTE (e.g., after major surgery, trauma, or prolonged immobilization).

Currently on Warfarin (interferes with Protein C/S results).

Currently on DOACs (Apixaban, Rivaroxaban, etc., interfere with Lupus Anticoagulant and functional assays).

Patient with unprovoked VTE who is already committed to lifelong anticoagulation.

Section 3

Pearls/Pitfalls

Will it Change Management?

Wait Time

Standard practice is to wait at least 2 weeks after stopping all anticoagulation (and at least 3-6 months after the acute event) before performing a formal thrombophilia screen.

Section 4

Evidence Appraisal

Primary Strategy

Guidance for the evaluation and treatment of hereditary and acquired thrombophilia.

Stevens SM et al. • Journal of Thrombosis and Thrombolysis. 2016;41(1):154-164.

View Source

Inherited thrombophilia: a double-edged sword.

Middeldorp S. • Hematology Am Soc Hematol Educ Program. 2016;2016(1):1-9.

View Source

Section 5

Literature

Consensus

Reflects the ASH (American Society of Hematology) Choosing Wisely recommendations to avoid unnecessary and misleading testing.

Last Comprehensive Review: 2026

Guidelines & Evidence

Clinical Details

Section 1

When to Use

When to Screen

First unprovoked Venous Thromboembolism (VTE) at a young age (typically < 45-50 years).

Strong family history of VTE (at least one first-degree relative with unprovoked VTE before age 50).

Recurrent unprovoked VTE.

VTE in unusual vascular beds (e.g., cerebral venous sinus, mesenteric, portal veins).

Skin necrosis induced by vitamin K antagonists (suggestive of Protein C deficiency).

The 'Golden Rule' of Timing

Section 2

Formula & Logic

Exclusion Criteria (Do NOT test if present)

Provoked VTE (e.g., after major surgery, trauma, or prolonged immobilization).

Currently on Warfarin (interferes with Protein C/S results).

Currently on DOACs (Apixaban, Rivaroxaban, etc., interfere with Lupus Anticoagulant and functional assays).

Patient with unprovoked VTE who is already committed to lifelong anticoagulation.

Section 3

Pearls/Pitfalls

Will it Change Management?

Wait Time

Standard practice is to wait at least 2 weeks after stopping all anticoagulation (and at least 3-6 months after the acute event) before performing a formal thrombophilia screen.

Section 4