Dr Murphy¹ supports a more discriminate approach to thrombophilia testing than I describe in my own practice² and points out that my opinion is at variance with British Committee for Standards in Haematology (BCSH) guidelines. In respect of the latter, these guidelines were not evidence based and were published 10 years ago. Dr Murphy identifies the main indications for thrombophilia testing from the guidelines as: (1) patients with venous thromboembolism before the age of 45 years, (2) recurrent venous thrombosis or thrombophlebitis, (3) thrombosis in an unusual site, and (4) a first venous thromboembolic event with a clear history of venous thrombosis. Applying current criteria for graded recommendations on levels of evidence these indications would be classified as grade C …