Abstract
Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness. To determine adherence of inpatient thrombophilia testing with institutional guidelines. A retrospective study to evaluate thrombophilia testing practices of adult patients who were admitted to Lehigh Valley Hospital at Cedar Crest with either venous thromboembolism or ischemic stroke in 2019. Testing included inherited and acquired thrombophilia. Patient charts were individually reviewed for three measured outcomes: 1) the number of appropriate thrombophilia testing in the inpatient setting; 2) the indications used for thrombophilia testing; 3) the proportion of positive thrombophilia tests with change in clinical management. 201 patients were included in our study. 26 patients (13%) were tested appropriately in accordance with institution guidelines and 175 (87%) patients were tested inappropriately. The most common reason for the inappropriate testing was testing during acute thrombosis. 28 of the 201 patients had positive thrombophilia tests, but the reviewers only noted 7 patients with change in clinical management-involving anticoagulation change. Our study revealed that a majority of inpatient thrombophilia testing did not follow institutional guidelines for appropriate testing and did not change patient management. These thrombophilia tests are often overutilized and have minimal clinical utility in the inpatient setting.
Highlights
The Virchow triad explains the pathogenesis of arterial and venous thrombotic disease in three broad categories: hypercoagulability, stasis, and endothelial damage
Patient charts were individually reviewed for three measured outcomes: 1) the number of appropriate thrombophilia testing in the inpatient setting; 2) the indications used for thrombophilia testing; 3) the proportion of positive thrombophilia tests with change in clinical management
The most common reason for the inappropriate testing was testing during acute thrombosis. 28 of the 201 patients had positive thrombophilia tests, but the reviewers only noted 7 patients with change in clinical management—involving anticoagulation change
Summary
The Virchow triad explains the pathogenesis of arterial and venous thrombotic disease in three broad categories: hypercoagulability, stasis, and endothelial damage. These categories can be due to acquired or genetic risk factors that predisposes patients into developing thrombosis. Testing can be done to determine if thrombophilia exist, but it is important to look at clinical risk factors when deciding on thrombophilia testing. This is highlighted by a statement from American Society of Hematology’s Choosing Wisely Campaign, which recommends against thrombophilia testing in the setting of major risk factors such as surgery, trauma, or prolonged immobility [1]. Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness
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