Thrombophilia Screening (Guidelines) | Right Decisions

Announcements and latest updates

The transfer of ownership of the Right Decision Service from the Digital Health & Care Innovation Centre to Healthcare Improvement Scotland was formally announced in a media release issued on 20th November 2023. This NHS ownership is key to embedding the Right Decision Service as a national asset for Scotland's health and care.

Quotations from this media release below:

Health Secretary, Michael Matheson, said:

“This is a groundbreaking example of a digital service that has been developed and piloted with our partners Digital Health and Care Innovation Centre (DHI) through to delivery. The programme is now transitioning into a national service in support of our workforce to be led by a national NHS Board (HIS) and highlights the success of our collaborative approach.

“I’d like to thank all of those involved in the development of the Right Decision Service and look forward to our health and care workforce being able to make greater use of decision support tools.” “I’d like to thank all those involves in the development of the Right Decision Service and look forward to the programmes future success.”

Safia Qureshi, Director of Evidence & Digital, Healthcare Improvement Scotland, comments:

"We are delighted that the Right Decision Service will be joining us, as it presents a unique opportunity to deliver our advice and guidance at the point of care. This will significantly benefit patient safety, making it easier for health and care professionals to access the information they need to make the right decisions, at the right time. We hope that the future development of the Right Decision Service will have a significant, positive impact for health and care staff, freeing up more of their time and using resources available to them as efficiently as possible.

"I would also like to thank the Digital Health & Care Innovation Centre for their outstanding work in establishing this invaluable service. We are really excited to embark on this exciting project together.”

Dr Ann Wales, Programme Lead for Knowledge and Decision Support, Healthcare Improvement Scotland, said:

“The Once for Scotland Right Decisions app is a step-change in support for evidence-based health and social care decisions. It harnesses the power of evidence and technology to bring decision-making tools to the fingertips of health and social care practitioners. It frees up practitioner time to care, enables safer, more consistent care and support across Scotland, and strengthens the focus on individuals’ needs.

“I am hugely grateful to the Digital Health & Care Innovation Centre for steering and championing the Right Decision Service through its early stages of development. I’m delighted that the service is now moving fully into the NHS with leadership from Healthcare Improvement Scotland. This will consolidate the role of the Right Decision Service as a driving force for evidence-based practice and improvement across Scotland.”

Professor George Crooks OBE, Chief Executive Officer, Digital Health & Care Innovation Centre (DHI), said:

“The transfer of the Right Decision service from DHI into Healthcare Improvement Scotland, where it will continue to flourish and add increasing value to the delivery of high quality, safe health and care services for the people of Scotland, demonstrates how a national innovation centre can support, nurture and grow a new digital service to the point where it can successfully move to national adoption and scale. DHI is a national asset that will continue to support the people of Scotland and importantly those charged with delivering health and care services to access world class digital health and care solutions.”

Right Decisions
TAM (Treatments and Medicines) NHS Highland
THERAPEUTIC GUIDELINES
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HAEMATOLOGY
Thrombophilia Screening (Guidelines)

BCSH guidelines on Thrombophilia
Pregnancy- Regarding Management and Prevention of VTE

Why not to...

The result whether positive or negative, rarely contributes to the management of any patient.
Some 5 to 10% of the population, of European origin, will have a genetic 'thrombophilia' BUT very few ever develop thrombosis.
Thrombophilia screening in unselected patients prior to oral contraceptive pills (OCP) or HRT use is not cost effective (screen 20,000 women to prevent 1 VTE, 2,000,000 to prevent 1 death).
A 'negative' result does not exclude thrombophilia due to as yet unidentified causes.

When might it be appropriate...

Only after appropriate counselling and the patient is in one of the categories below

When not to...

At Presentation of a thrombotic event - may give false positives.
During anticoagulant therapy - will produce false positives.
During Pregnancy - will produce false positives.
During Oestrogen therapy (e.g. Oral contraceptive pills or HRT) - will produce false positives.
In asymptomatic patients / family members under 18 years of age
If the Patient has suffered only arterial thromboses - such thromboses are not associated with hereditary thrombophilia. Consider lupus anticoagulant & anticardiolipin antibody testing in such patients who present at an unusually young age.

Abbreviations

Abbreviation	Meaning
HRT	Hormone Replacement Therapy
VTE	Venous Thromboembolism

Last reviewed: 31/03/2016

Next review date: 31/03/2018

Author(s): Consultant Haematologist.

Version: 2

Approved By: TAM subgroup of ADTC

Reviewer name(s): Dr Jo Craig.

Document Id: TAM222