American Society of Hematology-American Society of Pediatric Hematology/Oncology
View all recommendations from this societyReleased December 9, 2019
Don’t order thrombophilia testing on children with venous access (i.e., peripheral or central) associated thrombosis in the absence of a positive family history.
Testing for inherited forms of thrombophilia does not influence the initial management of a first episode of provoked venous thrombosis and should not be performed routinely. The results of such testing have not been shown to either predict recurrence of venous thrombosis or inform the intensity or duration of anticoagulant therapy. Thrombophilia testing has substantial financial cost, and a positive result has the potential for misinterpretation of risk assessment leading to undue psychological distress or impact on childbearing plans, as well as possible life insurance discrimination for affected patients.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Society of Hematology (ASH) and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a task force to solicit, evaluate, and select list items for a pediatric focused Choosing Wisely list. The panel was composed of 13 members – two co-chairs (representing ASH and ASPHO), five members selected by each organization, and one member serving as an advisor on Choosing Wisely methodology. Suggestions were solicited from the membership of both societies. Formal systematic reviews of the evidence were completed for eight semi-finalist items. Final item selections were made by the ASH-ASPHO CW task force with reference to the following six guiding principles: avoiding harm to patients, producing evidence-based recommendations, considering both the cost and frequency of tests and treatments, making recommendations in the clinical purview of the hematologist, and considering the potential impact of recommendations. Harm avoidance was established as the campaign’s preeminent guiding principle.
Sources
Baglin T, Gray E, Greaves M, Hunt BJ, Keeling D, Machin S, Mackie I, Makris M, Nokes T, Perry D, Tait RC, Walker I, Watson H. Clinical guidelines for testing for heritable thrombophilia. British Journal of Haematology. 2010 Apr;149(2)209-220.
Chalmers E, Ganesen V, Liesner R, Maroo S, Nokes T, Saunders D, Williams M. Guideline on the investigation, management and prevention of venous thrombosis in children. British Journal of Haematology. 2011 Jul;154(2)196-207.
National Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. 2015 Nov; Retrieved from www.nice.org.uk/guidance/cg144.
Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism. 2014 Oct; Retrieved from www.sign.ac.uk/sign-122-prevention-and-management-of-venous-thromboembolism.html.
