section name header

Table 20-6

Thrombophilia Testinga,b

Primary Tests (Recommended by ACOG)

  • Factor V Leiden DNA analysis

  • OR

  • Activated protein C resistance assay (second generation) followed by DNA analysis for Factor V Leiden if positive

  • Prothrombin G20210A genotype

  • Antithrombin activity

  • Protein C activity

  • Protein S activity

  • Lupus anticoagulant

  • Anticardiolipin antibodies (IgG and IgM)

  • Anti-β2-glycoprotein (IgG and IgM)

Other Tests (Not Recommended by ACOG)

  • 4G/4G PAI-1 mutation (if not available, plasma PAI-1 activity)

  • MTHFR mutation screen and/or fasting plasma homocysteine levels

Abbreviations: ACOG, American College of Obstetricians and Gynecologists; IgG, immunoglobulin G; IgM, immunoglobulin M; MTHFR, methylenetetrahydrofolate reductase; PAI-1, plasminogen activator inhibitor-1; PCR, polymerase chain reaction.


aTesting should be remote from thrombotic event, not during pregnancy, and while off anticoagulants, except DNA tests.
bAdapted with permission from American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 197: inherited thrombophilias in pregnancy. Obstet Gynecol. 2018;132(1):e18-e34. Copyright © 2018 by The American College of Obstetricians and Gynecologists.