{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T03:25:44Z","timestamp":1790220344023,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Thromb Thrombolysis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Hereditary thrombophilia testing is frequently ordered after venous thromboembolism (VTE), despite little evidence of clinical utility and most guidelines cautioning against testing. We conducted a retrospective, observational study of inpatient hereditary thrombophilia testing ordered during a hospital admission for acute VTE between 2019 and 2024. We aimed to characterize patterns of testing results, and costs, and to evaluate whether younger patients and those with unprovoked VTE were more likely to test positive for hereditary thrombophilia. A total of 835 hereditary thrombophilia tests \u2013 including those for factor V Leiden, prothrombin\n                    <jats:sub>G20210A<\/jats:sub>\n                    , deficiencies of protein S, protein C, and antithrombin, hyperhomocysteinemia, and plasminogen activator inhibitor-1 excess \u2013 were ordered in 220 patients. Overall, 19.6% of results were abnormal, and 45.0% of patients had at least one abnormal result. There was no difference in the rate of positive results among patients with provoked vs. unprovoked VTE (30.7% vs. 34.5%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.554) nor patients\u2009&lt;\u200950 vs.\u2009\u2265\u200950 years of age (33.1% vs. 32.4%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.912). Only 4\/99 (4.0%) patients with an abnormal result had their clinical management clearly changed due to the result. The tests totaled $385,161 USD in institutional charges and $26,029 USD in Medicare fees. Inpatient hereditary thrombophilia testing during admission for acute VTE is low yield, with frequent abnormal results, many of which likely represented false positives, and minimal impact on clinical management with high costs.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s11239-025-03183-2","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T18:42:09Z","timestamp":1759689729000},"page":"462-471","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical utility and costs of inpatient hereditary thrombophilia testing following acute VTE: A 5-Year retrospective study"],"prefix":"10.1007","volume":"59","author":[{"given":"Eliakim","family":"Munda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9638-0516","authenticated-orcid":false,"given":"Ruben","family":"Rhoades","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"issue":"9","key":"3183_CR1","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1111\/j.1538-7836.2004.00852.x","volume":"2","author":"CY Vossen","year":"2004","unstructured":"Vossen CY, Conard J, Fontcuberta J, Makris M, Van Der Meer FJ, Pabinger I et al (2004) Familial thrombophilia and lifetime risk of venous thrombosis. J Thromb Haemost 2(9):1526\u20131532. https:\/\/doi.org\/10.1111\/j.1538-7836.2004.00852.x","journal-title":"J Thromb Haemost"},{"issue":"23","key":"3183_CR2","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1001\/jama.2009.853","volume":"301","author":"JB Segal","year":"2009","unstructured":"Segal JB, Brotman DJ, Necochea AJ, Emadi A, Samal L, Wilson LM et al (2009) Predictive value of factor V Leiden and prothrombin G20210A in adults with venous thromboembolism and in family members of those with a mutation: a systematic review. JAMA 301(23):2472\u20132485. https:\/\/doi.org\/10.1001\/jama.2009.853","journal-title":"JAMA"},{"issue":"21","key":"3183_CR3","doi-asserted-by":"publisher","first-page":"5314","DOI":"10.1182\/blood-2008-10-184879","volume":"113","author":"WM Lijfering","year":"2009","unstructured":"Lijfering WM, Brouwer JL, Veeger NJ, Bank I, Coppens M, Middeldorp S et al (2009) Selective testing for thrombophilia in patients with first venous thrombosis: results from a retrospective family cohort study on absolute thrombotic risk for currently known thrombophilic defects in 2479 relatives. Blood 113(21):5314\u20135322. https:\/\/doi.org\/10.1182\/blood-2008-10-184879","journal-title":"Blood"},{"issue":"23","key":"3183_CR4","doi-asserted-by":"publisher","first-page":"2425","DOI":"10.1182\/blood.2023023326","volume":"143","author":"J Ryu","year":"2024","unstructured":"Ryu J, Ramo JT, Jurgens SJ, Niiranen T, Sanna-Cherchi S, Bauer KA et al (2024) Thrombosis risk in single- and double-heterozygous carriers of factor V Leiden and prothrombin G20210A in FinnGen and the UK biobank. Blood 143(23):2425\u20132432. https:\/\/doi.org\/10.1182\/blood.2023023326","journal-title":"Blood"},{"issue":"9383","key":"3183_CR5","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/S0140-6736(03)14111-6","volume":"362","author":"T Baglin","year":"2003","unstructured":"Baglin T, Luddington R, Brown K, Baglin C (2003) Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 362(9383):523\u2013526. https:\/\/doi.org\/10.1016\/S0140-6736(03)14111-6","journal-title":"Lancet"},{"issue":"19","key":"3183_CR6","doi-asserted-by":"publisher","first-page":"2352","DOI":"10.1001\/jama.293.19.2352","volume":"293","author":"SC Christiansen","year":"2005","unstructured":"Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR (2005) Thrombophilia, clinical factors, and recurrent venous thrombotic events. JAMA 293(19):2352\u20132361. https:\/\/doi.org\/10.1001\/jama.293.19.2352","journal-title":"JAMA"},{"issue":"7","key":"3183_CR7","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1001\/archinte.166.7.729","volume":"166","author":"WK Ho","year":"2006","unstructured":"Ho WK, Hankey GJ, Quinlan DJ, Eikelboom JW (2006) Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Arch Intern Med 166(7):729\u2013736. https:\/\/doi.org\/10.1001\/archinte.166.7.729","journal-title":"Arch Intern Med"},{"issue":"9","key":"3183_CR8","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1111\/j.1538-7836.2008.03055.x","volume":"6","author":"M Coppens","year":"2008","unstructured":"Coppens M, Reijnders JH, Middeldorp S, Doggen CJ, Rosendaal FR (2008) Testing for inherited thrombophilia does not reduce the recurrence of venous thrombosis. J Thromb Haemost 6(9):1474\u20131477. https:\/\/doi.org\/10.1111\/j.1538-7836.2008.03055.x","journal-title":"J Thromb Haemost"},{"issue":"12","key":"3183_CR9","doi-asserted-by":"publisher","first-page":"4432","DOI":"10.1182\/blood-2008-06-163279","volume":"112","author":"C Kearon","year":"2008","unstructured":"Kearon C, Julian JA, Kovacs MJ, Anderson DR, Wells P, Mackinnon B (2008) Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood 112(12):4432\u20134436. https:\/\/doi.org\/10.1182\/blood-2008-06-163279","journal-title":"Blood"},{"issue":"8038","key":"3183_CR10","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/s0140-6736(77)91429-5","volume":"2","author":"E Marciniak","year":"1977","unstructured":"Marciniak E, Gockerman JP (1977) Heparin-induced decrease in circulating antithrombin-III. Lancet 2(8038):581\u2013584. https:\/\/doi.org\/10.1016\/s0140-6736(77)91429-5","journal-title":"Lancet"},{"issue":"2","key":"3183_CR11","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1172\/JCI112319","volume":"77","author":"D Vigano","year":"1986","unstructured":"Vigano D, Comp PC, Esmon CT, D\u2019Angelo A (1986) Relationship between protein C antigen and anticoagulant activity during oral anticoagulation and in selected disease states. J Clin Invest 77(2):416\u2013425. https:\/\/doi.org\/10.1172\/JCI112319","journal-title":"J Clin Invest"},{"issue":"10","key":"3183_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107308","volume":"32","author":"S Majmundar","year":"2023","unstructured":"Majmundar S, Thapa S, Miller ES, Bell R, Dharia R, Tzeng D et al (2023) Low value of inherited thrombophilia testing among patients with stroke or transient ischemic attack: a three-year retrospective study. J Stroke Cerebrovasc Dis 32(10):107308. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2023.107308","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"9","key":"3183_CR13","doi-asserted-by":"publisher","first-page":"705","DOI":"10.12788\/jhm.2804","volume":"12","author":"N Cox","year":"2017","unstructured":"Cox N, Johnson SA, Vazquez S, Fleming RP, Rondina MT, Kaplan D et al (2017) Patterns and appropriateness of thrombophilia testing in an academic medical center. J Hosp Med 12(9):705\u2013709. https:\/\/doi.org\/10.12788\/jhm.2804","journal-title":"J Hosp Med"},{"issue":"9","key":"3183_CR14","doi-asserted-by":"publisher","first-page":"e0257687","DOI":"10.1371\/journal.pone.0257687","volume":"16","author":"CT Siu","year":"2021","unstructured":"Siu CT, Wolfe Z, DelaTorre M, Rehim E, Decker R, Zaffiri K et al (2021) Evaluation of thrombophilia testing in the inpatient setting: a single institution retrospective review. PLoS ONE 16(9):e0257687. https:\/\/doi.org\/10.1371\/journal.pone.0257687","journal-title":"PLoS ONE"},{"issue":"5","key":"3183_CR15","doi-asserted-by":"publisher","first-page":"e0155326","DOI":"10.1371\/journal.pone.0155326","volume":"11","author":"YM Shen","year":"2016","unstructured":"Shen YM, Tsai J, Taiwo E, Gavva C, Yates SG, Patel V et al (2016) Analysis of thrombophilia test ordering practices at an academic center: a proposal for appropriate testing to reduce harm and cost. PLoS ONE 11(5):e0155326. https:\/\/doi.org\/10.1371\/journal.pone.0155326","journal-title":"PLoS ONE"},{"issue":"8","key":"3183_CR16","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1001\/jamainternmed.2017.1815","volume":"177","author":"A Gupta","year":"2017","unstructured":"Gupta A, Sarode R, Nagalla S (2017) Thrombophilia testing in provoked venous thromboembolism: a teachable moment. JAMA Intern Med 177(8):1195\u20131196. https:\/\/doi.org\/10.1001\/jamainternmed.2017.1815","journal-title":"JAMA Intern Med"},{"issue":"8","key":"3183_CR17","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1038\/gim.2016.209","volume":"19","author":"JA Lynch","year":"2017","unstructured":"Lynch JA, Berse B, Dotson WD, Khoury MJ, Coomer N, Kautter J (2017) Utilization of genetic tests: analysis of gene-specific billing in medicare claims data. Genet Med 19(8):890\u2013899. https:\/\/doi.org\/10.1038\/gim.2016.209","journal-title":"Genet Med"},{"issue":"2","key":"3183_CR18","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1111\/j.1365-2141.2009.08022.x","volume":"149","author":"T Baglin","year":"2010","unstructured":"Baglin T, Gray E, Greaves M, Hunt BJ, Keeling D, Machin S et al (2010) Clinical guidelines for testing for heritable thrombophilia. Br J Haematol 149(2):209\u2013220. https:\/\/doi.org\/10.1111\/j.1365-2141.2009.08022.x","journal-title":"Br J Haematol"},{"issue":"1","key":"3183_CR19","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/GIM.0b013e3181fbe46f","volume":"13","author":"G Prevention Working","year":"2011","unstructured":"Evaluation of Genomic Applications in P, Prevention Working G (2011) Recommendations from the EGAPP working group: routine testing for factor V Leiden (R506Q) and prothrombin (20210G\u2009>\u2009A) mutations in adults with a history of idiopathic venous thromboembolism and their adult family members. Genet Med 13(1):67\u201376. https:\/\/doi.org\/10.1097\/GIM.0b013e3181fbe46f","journal-title":"Genet Med"},{"issue":"24","key":"3183_CR20","doi-asserted-by":"publisher","first-page":"3879","DOI":"10.1182\/blood-2013-07-518423","volume":"122","author":"LK Hicks","year":"2013","unstructured":"Hicks LK, Bering H, Carson KR, Kleinerman J, Kukreti V, Ma A (2013) The ASH Choosing Wisely\u00ae campaign: five hematologic tests and treatments to question. Blood 122(24):3879\u20133883. https:\/\/doi.org\/10.1182\/blood-2013-07-518423","journal-title":"Blood"},{"issue":"3","key":"3183_CR21","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/bjh.18239","volume":"198","author":"DJ Arachchillage","year":"2022","unstructured":"Arachchillage DJ, Mackillop L, Chandratheva A, Motawani J, MacCallum P, Laffan M (2022) Thrombophilia testing: a British society for haematology guideline. Br J Haematol 198(3):443\u2013458. https:\/\/doi.org\/10.1111\/bjh.18239","journal-title":"Br J Haematol"},{"issue":"22","key":"3183_CR22","doi-asserted-by":"publisher","first-page":"7101","DOI":"10.1182\/bloodadvances.2023010177","volume":"7","author":"S Middeldorp","year":"2023","unstructured":"Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, Coppens M, Houghton D, James AH et al (2023) American society of hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv 7(22):7101\u20137138. https:\/\/doi.org\/10.1182\/bloodadvances.2023010177","journal-title":"Blood Adv"},{"issue":"7","key":"3183_CR23","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1111\/jth.13336","volume":"14","author":"C Kearon","year":"2016","unstructured":"Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA et al (2016) Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 14(7):1480\u20131483. https:\/\/doi.org\/10.1111\/jth.13336","journal-title":"J Thromb Haemost"},{"issue":"7","key":"3183_CR24","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.1111\/jth.14836","volume":"18","author":"M Di Nisio","year":"2020","unstructured":"Di Nisio M, Valeriani E, Riva N, Schulman S, Beyer-Westendorf J, Ageno W (2020) Anticoagulant therapy for splanchnic vein thrombosis: ISTH SSC subcommittee control of anticoagulation. J Thromb Haemost 18(7):1562\u20131568. https:\/\/doi.org\/10.1111\/jth.14836","journal-title":"J Thromb Haemost"},{"key":"3183_CR25","doi-asserted-by":"publisher","unstructured":"Heit JA, Mohr DN, Silverstein MD, Petterson TM, O\u2019Fallon WM, Melton LJ 3 (2000) Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 160(6):761\u2013768. https:\/\/doi.org\/10.1001\/archinte.160.6.761","DOI":"10.1001\/archinte.160.6.761"},{"issue":"1","key":"3183_CR26","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s11239-019-01930-w","volume":"49","author":"R Virparia","year":"2020","unstructured":"Virparia R, Brunetti L, Vigdor S, Adams CD (2020) Appropriateness of thrombophilia testing in patients in the acute care setting and an evaluation of the associated costs. J Thromb Thrombolysis 49(1):108\u2013112. https:\/\/doi.org\/10.1007\/s11239-019-01930-w","journal-title":"J Thromb Thrombolysis"},{"issue":"6","key":"3183_CR27","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/j.thromres.2015.10.019","volume":"136","author":"MR Meyer","year":"2015","unstructured":"Meyer MR, Witt DM, Delate T, Johnson SG, Fang M, Go A et al (2015) Thrombophilia testing patterns amongst patients with acute venous thromboembolism. Thromb Res 136(6):1160\u20131164. https:\/\/doi.org\/10.1016\/j.thromres.2015.10.019","journal-title":"Thromb Res"},{"issue":"3","key":"3183_CR28","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1055\/s-0040-1714334","volume":"4","author":"M Gaddh","year":"2020","unstructured":"Gaddh M, Cheng E, Elsebaie MAT, Bodo I (2020) Clinical utilization and cost of thrombophilia testing in patients with venous thromboembolism. TH Open 4(3):e153\u2013e62. https:\/\/doi.org\/10.1055\/s-0040-1714334","journal-title":"TH Open"},{"issue":"1","key":"3183_CR29","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1358863X17742509","volume":"23","author":"MY Lim","year":"2018","unstructured":"Lim MY, Greenberg CS (2018) Inpatient thrombophilia testing: impact of healthcare system technology and targeted clinician education on changing practice patterns. Vasc Med 23(1):78\u201379. https:\/\/doi.org\/10.1177\/1358863X17742509","journal-title":"Vasc Med"},{"issue":"23","key":"3183_CR30","doi-asserted-by":"publisher","first-page":"2298","DOI":"10.1056\/NEJMc1713797","volume":"377","author":"JM Connors","year":"2017","unstructured":"Connors JM (2017) Thrombophilia testing and venous thrombosis. N Engl J Med 377(23):2298. https:\/\/doi.org\/10.1056\/NEJMc1713797","journal-title":"N Engl J Med"},{"issue":"11","key":"3183_CR31","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1002\/jhm.2616","volume":"11","author":"CM Petrilli","year":"2016","unstructured":"Petrilli CM, Heidemann L, Mack M, Durance P, Chopra V (2016) Inpatient inherited thrombophilia testing. J Hosp Med 11(11):801\u2013804. https:\/\/doi.org\/10.1002\/jhm.2616","journal-title":"J Hosp Med"},{"issue":"9","key":"3183_CR32","doi-asserted-by":"publisher","first-page":"783","DOI":"10.12788\/jhm.2818","volume":"12","author":"B Berse","year":"2017","unstructured":"Berse B, Lynch JA, Bowen S, Grosse SD (2017) In reference to: cost and utility of thrombophilia testing. J Hosp Med 12(9):783. https:\/\/doi.org\/10.12788\/jhm.2818","journal-title":"J Hosp Med"}],"container-title":["Journal of Thrombosis and Thrombolysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11239-025-03183-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11239-025-03183-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11239-025-03183-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T08:23:02Z","timestamp":1774426982000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11239-025-03183-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["3183"],"URL":"https:\/\/doi.org\/10.1007\/s11239-025-03183-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7024163\/v1","asserted-by":"object"}]},"ISSN":["1573-742X"],"issn-type":[{"value":"1573-742X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]},"assertion":[{"value":"2 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}