Jornal de Hematologia e Doenças Tromboembólicas
Acesso livre

Abstrato

The Utility of Thrombophilia Testing in the Acute Care Setting

Millet R, Meisenberg B

Background: Acquired or congenital thrombophilia increases the risk of thrombosis but routine testing of all patients with thrombosis is not recommended. Inpatient ordering of thrombophilia testing is additionally problematic because the tests are moderately costly, hard to interpret and do not alter the inpatient course. Despite this, inpatient ordering still occurs. We studied the utility of thrombophilia testing in a community hospital. Methods: The electronic medical records of consecutive patients having thrombophilia testing were reviewed for demographics, diagnoses, specialty of the ordering physician, role of hematology or other consultants, and the extent of duplicate testing. Results: Most testing was ordered by hospitalists with no documented input from hematologists or laboratory medicine specialists. Testing met professional society guidelines in only one patient. Some testing duplicated what was already present in the electronic medical record. One patient was harmed by thrombophilia testing, being incorrectly diagnosed with lupus-like anticoagulant syndrome. After data analysis, routine thrombophilia test options were removed from the ordering panel of the electronic medical records and became available only upon special request. In the 9 months after this intervention, only one request for the thrombophilia testing was received. Restricting thrombophilia testing resulted in estimated cost savings of $45,000 annually. Conclusions: Thrombophilia testing in the acute care setting was almost always ordered outside of clinical guidelines and provided no benefit. None of the “abnormal” tests were clinically significant. Over interpretation of one abnormal test lead to incorrect recommendations for long term anticoagulation in one patient. Hospitals, both teaching and non-teaching, should review their own experiences and consider locally appropriate ways to reduced overutilization.