Evaluation of thrombophilia testing in the inpatient setting: A single institution retrospective review

• Published in: PloS one 2021-09, Vol.16 (9), p.e0257687
• Main Authors: Siu, Chun Ting, Wolfe, Zachary, DelaTorre, Martin, Rehim, Erafat, Decker, Robert, Zaffiri, Kathryn, Lash, Bradley
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants; Anticoagulants - therapeutic use; Antigens; Earth Sciences; Electronic health records; Evaluation; Female; Guideline Adherence - statistics & numerical data; Guidelines; Health care networks; Health risks; Hematology; Hospitals; Humans; Inpatients; Internal medicine; Ischemia; Laboratories; Male; Medical tests; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mutation; Oncology; Patients; Proteins; Research and Analysis Methods; Retrospective Studies; Risk factors; Thromboembolism; Thrombophilia; Thrombophilia - diagnosis; Thrombophilia - drug therapy; Thrombosis; Veins & arteries; Venous Thromboembolism - diagnosis; Venous Thromboembolism - drug therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0257687

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.