Thrombophilia testing is costly and can result in harm to patients if the duration of anticoagulation is inappropriately prolonged or if patients are incorrectly labeled as thrombophilic. Thrombophilia testing does not change the management of VTEs occurring in the setting of major transient VTE risk factors.

Chong LY, Fenu E, Stansby G, Hodgkinson S. Management of venous thromboembolic diseases and the role of thrombophilia testing: summary of NICE guidance. British Medical Journal 2012; 344: e3979

Wai KH, Hankey GJ, Eikelboom JW. Should adult patients be routinely tested for heritable thrombophilia after an episode of venous thromboembolism? Medical Journal of Australia 2011; 195(3): 139-142

Wu O, Robertson L, Twaddle S, Lowe GD, Clark P, Greaves M, Walker ID, Langhorne P, Brenkel I, Regan L, Greer I. Screening for thrombophilia in high-risk situations: Systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study, Health Technology Assessment 2006; 10(11): 1-110

CT surveillance in asymptomatic patients in remission from aggressive lymphoma may be harmful due to a small but cumulative risk of radiation-induced malignancy. It is also costly and has not been demonstrated to improve survival. Therefore the anticipated benefits of posttreatment CT scans should be weighed against the potential harm of radiation exposure.

Due to a decreasing probability of relapse with the passage of time and a lack of proven benefit, CT scans in asymptomatic patients more than 2 years beyond the completion of treatment are rarely advisable.

Thompson CA, Ghesquieres H, Maurer MJ. Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma. Journal of Clinical Oncology 2014; 32: 3506-3512

Huntington SF, Svoboda J, Doshi JA. Cost-effectiveness analysis of routine surveillance imaging of patients with diffuse large B-cell lymphoma in first remission. Journal of Clinical Oncology 2015; 33(13): 1467-1474

Cheah CY, Dickinson M, Hofman MS. Limited clinical benefit for surveillance PET-CT scanning in patients with histologically transformed lymphoma in complete metabolic remission following primary therapy. Annals of Haematology 2014; 93: 1193-1200

Lin TL, Kuo MC, Shih LY, Dunn P, Wang PN, Wu JH, Tang TC, Chang H, Hung YS, Lu SC. Value of surveillance computed tomography in the follow-up of diffuse large B-cell and follicular lymphomas. Annals of Haematology 2012; 91(11): 1741–5

Thompson CA, Charlson ME, Schenkein E. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Annals of Oncology 2010; 21: 2262-2266

Shenoy P, Sinha R, Tumeh JW, Lechowicz MJ, Flowers CR. Surveillance computed tomography scans for patients with lymphoma: is the risk worth the benefits? Clinical Lymphoma Myeloma Leukemia 2010; 10(4): 270–7

Guppy AE, Tebbutt NC, Norman A, Cunningham D. The role of surveillance CT scans in patients with diffuse large B-cell nonHodgkin’s lymphoma. Clinical Lymphoma Myeloma Leukemia 2003; 44(1): 123–5

Anticoagulation is potentially harmful and costly. Patients with a first VTE triggered by a major, transient risk factor are at low risk for recurrence once the risk factor has resolved and an adequate treatment regimen with anticoagulation has been completed.

Evidence-based and consensus guidelines recommend three months of anticoagulation over shorter or longer periods of anticoagulation in patients with VTE in the setting of a reversible provoking factor.

Kearon C, Akl EA, Comerota AJ. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 141 (suppl 2): e419S-e494S

Boutitie F, Pinede L, Schulman S, Agnelli G, Raskob G, Julian J, Hirsh J, Kearon C. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: Analysis of individual participants’ data from seven trials. British Medical Journal 2011; 342: d3036

In patients with asymptomatic, early-stage CLL, baseline and routine surveillance CT scans do not improve survival and are not necessary to stage or prognosticate patients. CT scans expose patients to small doses of radiation, and can detect incidental findings that are not clinically relevant but lead to further investigations and are costly.    

For asymptomatic patients with early-stage CLL, clinical staging and blood monitoring is recommended over CT scans.

Oscier D, Dearden C, Eren E, Fegan C, Follows G, Hillmen P, Illidge T, Matutes E, Milligan DW, Pettitt A, Schuh A, Wimperis J. British Committee for Standards in Haematology: Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia. British Journal of Haematology 2012; 159(5): 541–64

Eichhorst B, Hallek M, Dreyling M, Group EGW. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2010; 21 Suppl 5: 162–4

Hallek M, Cheson BD, Catovsky D. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: A report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111: 5446-5456

Treatment for ITP should be aimed at treating and preventing bleeding episodes and improving quality of life. Unnecessary treatment exposes patients to potentially serious treatment side effects and can be costly, with little expectation of clinical benefit. Unless they are preparing for surgery or an invasive procedure, or have a significant additional risk factor for bleeding, ITP treatment is rarely indicated for adult patients with platelet counts greater than 30,000/L

In patients preparing for surgery or other invasive procedures, short-term treatment may be indicated to increase the platelet count prior to the planned intervention and during the immediate post-operative period.    

Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr., Crowther MA. The American Society of Haematology 2011: Evidence based practice guideline for immune thrombocytopenia. Blood 2011; 117(16): 4190–207