Somma Jonathan, Sussman Ira I, Rand Jacob H
Department of Pathology, Montefiore Medical Center, Bronx, NY 10467, USA.
Am J Clin Pathol. 2006 Jul;126(1):120-7. doi: 10.1309/KV06-32LJ-8EDM-EWQT.
To evaluate the utilization of thrombophilia screening at a large urban academic tertiary care center, we retrospectively examined the indications, appropriateness, and results of 200 consecutive thrombophilia panels. Of the panels, 103 (51.5%) were ordered for venous thromboembolism; 124 (62.0%) were ordered during acute thrombotic episodes, and at least 40 (20.0%) had abnormal protein C and S results, of which 25 (63%) were attributable to anticoagulation and the remainder to pregnancy. Of the 200 panels, 46 (23.0%) had a significant abnormality; the most common abnormal result was a lupus anticoagulant, occurring in 23 cases (11.3%). Thrombophilia screening seems to be overutilized in our population, especially considering that the majority of tests are ordered during suboptimal conditions, eg, acute thrombosis, pregnancy, or anticoagulation. At present, outside the research setting, thrombophilia panels should be reserved for special circumstances, targeted to factors for which there would be a specific clinical impact, and performed in the absence of confounding clinical variables.
为评估一家大型城市学术性三级医疗中心的血栓形成倾向筛查的应用情况，我们回顾性研究了连续200例血栓形成倾向检测的指征、合理性及结果。在这些检测中，103例（51.5%）因静脉血栓栓塞而开具；124例（62.0%）在急性血栓形成发作期间开具，至少40例（20.0%）蛋白C和S结果异常，其中25例（63%）归因于抗凝治疗，其余归因于妊娠。在200例检测中，46例（23.0%）有显著异常；最常见的异常结果是狼疮抗凝物，有23例（11.3%）。在我们的人群中，血栓形成倾向筛查似乎存在过度使用的情况，尤其是考虑到大多数检测是在欠佳的情况下开具的，例如急性血栓形成、妊娠或抗凝治疗期间。目前，在研究环境之外，血栓形成倾向检测应仅用于特殊情况，针对那些会产生特定临床影响的因素，并在不存在混淆临床变量的情况下进行。
