Nicholas Cox1, Stacy A Johnson2,3, Sara Vazquez2, Ryan P Fleming2, Matthew T Rondina2,3,4,5, David Kaplan2,3, Stephanie Chauv6, Gabriel V Fontaine6, Scott M Stevens3,6, Scott Woller3,6, Daniel M Witt2,7. 1. University of Utah Health Care, Salt Lake City, Utah, USA. nicholas.cox@pharm.utah.edu. 2. University of Utah Health Care, Salt Lake City, Utah, USA. 3. Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. 4. GRECC, George E. Wahlen VAMC, Salt Lake City, Utah, USA. 5. Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA. 6. Intermountain Healthcare, Salt Lake City, Utah, USA. 7. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
Abstract
BACKGROUND: Clinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event. OBJECTIVE: To determine appropriateness of thrombophilia testing in a teaching hospital. DESIGN: Retrospective cohort study. SETTING: One academic medical center in Utah. PARTICIPANTS: All patients who received thrombophilia testing between July 1, 2014, and December 31, 2014. MAIN MEASUREMENTS: Proportion of thrombophilia tests occurring in situations associated with minimal clinical utility, defined as tests meeting at least 1 of the following criteria: discharged before results available; test type not recommended; testing in situations associated with decreased accuracy; duplicate testing; and testing following a provoked thrombotic event. RESULTS: Overall, 163 patients received a total of 1451 thrombophilia tests for stroke (50% of tests; 35% of patients), venous thromboembolism (21% of tests; 21% of patients), and pregnancy-related conditions (15% of tests; 25% of patients). Of the 39 different test types performed, the most common were cardiolipin IgG and IgM antibodies (9% each), lupus anticoagulant (9%), and ß2-glycoprotein 1 IgG and IgM antibodies (8% each). In total, 911 tests (63%) were performed in situations associated with minimal clinical utility, with 126 patients (77%) receiving at least one such test. Only 2 patients (1%) had clear documentation of being offered genetic consultation. CONCLUSIONS: Thrombophilia testing in this single-center study was often associated with minimal clinical utility. Strategies to improve testing practices (eg, hematology specialty consult prior to inpatient testing, improved order panels) might help minimize inappropriate testing and promote value-driven care.
BACKGROUND: Clinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event. OBJECTIVE: To determine appropriateness of thrombophilia testing in a teaching hospital. DESIGN: Retrospective cohort study. SETTING: One academic medical center in Utah. PARTICIPANTS: All patients who received thrombophilia testing between July 1, 2014, and December 31, 2014. MAIN MEASUREMENTS: Proportion of thrombophilia tests occurring in situations associated with minimal clinical utility, defined as tests meeting at least 1 of the following criteria: discharged before results available; test type not recommended; testing in situations associated with decreased accuracy; duplicate testing; and testing following a provoked thrombotic event. RESULTS: Overall, 163 patients received a total of 1451 thrombophilia tests for stroke (50% of tests; 35% of patients), venous thromboembolism (21% of tests; 21% of patients), and pregnancy-related conditions (15% of tests; 25% of patients). Of the 39 different test types performed, the most common were cardiolipin IgG and IgM antibodies (9% each), lupus anticoagulant (9%), and ß2-glycoprotein 1 IgG and IgM antibodies (8% each). In total, 911 tests (63%) were performed in situations associated with minimal clinical utility, with 126 patients (77%) receiving at least one such test. Only 2 patients (1%) had clear documentation of being offered genetic consultation. CONCLUSIONS:Thrombophilia testing in this single-center study was often associated with minimal clinical utility. Strategies to improve testing practices (eg, hematology specialty consult prior to inpatient testing, improved order panels) might help minimize inappropriate testing and promote value-driven care.
Authors: Tomi Jun; Henry Kwang; Eric Mou; Caroline Berube; Jason Bentley; Lisa Shieh; Jason Hom Journal: J Gen Intern Med Date: 2019-01 Impact factor: 5.128
Authors: Henry Kwang; Eric Mou; Ilana Richman; Andre Kumar; Caroline Berube; Rajani Kaimal; Neera Ahuja; Stephanie Harman; Tyler Johnson; Neil Shah; Ronald Witteles; Robert Harrington; Lisa Shieh; Jason Hom Journal: BMC Med Inform Decis Mak Date: 2019-08-20 Impact factor: 2.796
Authors: Thita Chiasakul; Elizabeth De Jesus; Jiayi Tong; Yong Chen; Mark Crowther; David Garcia; Chatree Chai-Adisaksopha; Steven R Messé; Adam Cuker Journal: J Am Heart Assoc Date: 2019-09-24 Impact factor: 5.501