Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study

BACKGROUND: Thrombophilia is a recognised risk factor for venous thromboembolism (VTE). However, the optimal management is unclear in terms of the need for and effectiveness of antithrombotic interventions, especially in high-risk patient groups, including the use of oral oestrogen preparations, pregnancy and major orthopaedic surgery. Clinicians have come under pressure to initiate thrombophilia testing on an increasing number of patients and thrombophilia screening in selected patient groups has been suggested.

OBJECTIVES: To assess the risk of clinical complications associated with thrombophilia in three high-risk patient groups: women using oral oestrogen preparations, women during pregnancy and patients undergoing major orthopaedic surgery.

To assess the effectiveness of prophylactic treatments in preventing venous thromboembolism (VTE) and adverse pregnancy outcomes in women with thrombophilia during pregnancy and VTE in patients with thrombophilia, undergoing major orthopaedic surgery.

To evaluate the relative cost-effectiveness of universal and selective VTE history-based screening for thrombophilia compared with no screening in the three high-risk patient groups.