Thrombophilias and VTE risk in contraception

Do not routinely screen for thrombophilias before starting combined hormonal contraception; screening is not cost-effective or clinically helpful.

Use of combined hormonal contraception is not recommended without expert clinical judgment or referral if there is a family history of VTE in a first-degree relative before age 45 years (provoked or unprovoked). Although screening for thrombophilias can be considered in this situation, a negative screen may not exclude all thrombogenic mutations.