For patients with a history of pregnancy loss, do you evaluate for PAI-1 polymorphisms as part of a thrombophilia workup?

I do not.

The relationship between PAI-1 polymorphisms and thrombosis is complicated, and general guidance suggests against assessing for PAI-1 overexpression as part of a thrombophilia workup. While there is some data to suggest an association between PAI-1 polymorphisms and pregnancy loss, ALIFE2 showed that anticoagulation did not result in higher live birth rates in women with recurrent pregnancy loss and thrombophilia. While PAI-1 overexpression was not a specific thrombophilia evaluated in that study (for reasons noted above), I would expect the same data to hold true for that population. As such, I suppose that PAI-1 testing could be pursued as a possible associative correlation with pregnancy loss, but the presence or absence of a mu...