Inherited Thrombophilia Workup

Testing indications (BSH): • Unprovoked VTE in patient <50. • Recurrent VTE. • VTE in unusual site (cerebral, splanchnic, hepatic vein). • VTE in pregnancy / postpartum / on combined OCP / HRT. • Family history of VTE in first-degree relative + affected by VTE. • Recurrent miscarriage (≥3) or late fetal loss / placental complications (antiphospholipid). • Warfarin-induced skin necrosis (protein C/S deficiency). Do NOT test: • Routine first VTE in older patient with provoking factor. • Acute VTE — many tests inaccurate during anticoagulation. • Without genetic counselling for hereditary thrombophilia. • Asymptomatic relatives unless clinically indicated.