With the purpose of standardizing the laboratory investigation of thrombophilia in the female population, we decided, along with the medical staff of Hospital Israelita Albert Einstein, to create the Thrombophilia Forum with hematologists, vascular surgeons, and gynecologists/obstetricians of the organization, to evaluate the true importance of this investigation, its management, and to define, by consensus, the standardization of measures that should be taken in caring for our target population.
The Thrombophilia Forum was held on June 10th, 2017, at Hospital Israelita Albert Einstein, in the city of São Paulo (SP), Brazil.
The hematology team of Hospital Israelita Albert Einstein (HIAE) performed a search, in April 2017, of scientific articles published in PubMed®/MEDLINE® between January 2007 and January 2017, inserting the words in English: “thrombophilia”, “thrombosis and pregnancy”, “thrombophilia and screening”, “pre-hormone therapy”. The retrieved articles were analyzed as to their relevance, scope, and study design, which generated a list of randomized clinical studies, meta-analyses, systematic reviews, and guidelines,(1,6-11) which was forwarded as a suggestion of reading via e-mail to the medical staff of the 539 specialist physicians registered in hematology, vascular surgery, and gynecology and obstetrics. It was accompanied by an invitation letter to a forum scheduled 2 weeks after the receipt of the e-mail. Of these, 107 physicians (80% gynecologists/obstetricians, 10% hematologists, and 10% vascular surgeons) attended the Forum that lasted 4 hours and 30 minutes and was composed of three stages: theoretical class to expose the theme of thrombophilia in women; interactive presentation of clinical cases in which the participants of the forum could expose their questions and comments; and exposure of a questionnaire prepared by the hematology team of HIAE, with 21 statements that illustrated the main medical managements about the topic addressed (thrombophilia in women). The participants should assess each statement and vote as true, to agree with the medical management explained, or false, to disagree with it. An electronic voting system was installed in the auditorium, with individual equipment, allowing the recording of the percentage of answers (true and false). The material utilized for the presentation of the theoretical class and the clinical cases are available in the supplementary materials (links at the end of this article).
A 80%-agreement in the vote for insertion of each recommendation was established by the group of physicians present at the Forum as a minimal criterion of acceptable resolution, so that the statement was inserted into the final document. Cases in which there was agreement lower than 80% were again discussed, and a consensual agreement was reached for majority conduct.
After literature review, reading of the bibliography, exposition of the literature in a plenary meeting, dynamic discussion of clinical cases, and voting on the consensus, we reached agreement of more than 80% in 95% of questions (20 out of 21), whereas only one of the questions had less than 80% votes. This question, after ample discussion, was reformulated and agreed upon by unanimity. The result of the consensus voting is presented in its entirety in the supplementary material (links).