Alidoost Marjan, Conte Gabriella A, Gupta Varsha, Patel Swapnil, Patel Ishan, Shariff Mohammed, Gor Shreya, Levitt Michael J, Asif Arif, Hossain Mohammad A
Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA.
J Blood Med. 2021 May 28;12:369-376. doi: 10.2147/JBM.S271478. eCollection 2021.
Venous thromboembolism is a significant clinical event, with an annual incidence of 1-2 per 1000 population. Risk factors include recent surgery, prolonged immobility, oral contraceptive use, and active cancer. Inherited risks include protein C and S deficiencies, antithrombin deficiency, factor V Leiden mutation and prothrombin. These factors can be tested to guide therapy, but current evidence suggests that testing for inherited thrombophilia is not recommended in most inpatient settings. In the era of high value care, hypercoagulable testing for VTE creates a financial burden for the hospital and patients. We performed a retrospective chart review of hypercoagulable orders on VTE patients at our institution.
Institutional Review Board approval was obtained. A total of 287 adult patients admitted over a 3-month period with the diagnosis of VTE were included. Patients were identified via ICD-10 codes and data were collected from electronic medical records. Patient characteristics, provoked versus unprovoked VTE, and relative contraindications for hypercoagulability work-up were analyzed. Our primary outcome was to assess the appropriateness of thrombophilia testing in VTE patients based on screening guidelines. Our secondary outcome was to analyze the cost burden of ordering these tests.
A total of 287 patients were included in our data analysis. Patient risk factors for VTE were malignancy, previous DVT, immobilization, surgery 3 months prior, and central line placement. Fifty-seven of 287 patients had at least one hypercoagulable test ordered during hospitalization which did not adhere to guidelines. Misuse of testing occurred during active thrombosis, active anticoagulation, presence of risk factors, first episode of VTE, and malignancy. The cost of ordering these 5 thrombophilia tests totaled over $40,000.
In our study, numerous patients were tested without compliance to standard recommendations, which created financial and value-based burdens on our health care system. Increased awareness among clinicians is thus warranted to ensure high value care.
静脉血栓栓塞是一种重大临床事件，年发病率为每1000人中有1 - 2例。危险因素包括近期手术、长期制动、使用口服避孕药和患有活动性癌症。遗传性风险因素包括蛋白C和S缺乏、抗凝血酶缺乏、因子V莱顿突变和凝血酶原。这些因素可进行检测以指导治疗，但目前证据表明，在大多数住院患者中不建议进行遗传性易栓症检测。在高价值医疗时代，对静脉血栓栓塞进行高凝状态检测给医院和患者带来了经济负担。我们对本机构静脉血栓栓塞患者的高凝检测医嘱进行了回顾性病历审查。
获得了机构审查委员会的批准。纳入了在3个月期间收治的共287例诊断为静脉血栓栓塞的成年患者。通过ICD - 10编码识别患者，并从电子病历中收集数据。分析了患者特征、诱因性与非诱因性静脉血栓栓塞以及高凝状态检查的相对禁忌证。我们的主要结果是根据筛查指南评估静脉血栓栓塞患者进行易栓症检测的适宜性。我们的次要结果是分析开具这些检测的成本负担。
共有287例患者纳入我们的数据分析。静脉血栓栓塞的患者风险因素为恶性肿瘤、既往深静脉血栓形成、制动、3个月前的手术以及中心静脉置管。287例患者中有57例在住院期间至少进行了一项不符合指南的高凝检测。在活动性血栓形成、积极抗凝、存在风险因素、静脉血栓栓塞首发以及恶性肿瘤期间发生了检测滥用。开具这5项易栓症检测的费用总计超过40,000美元。
在我们的研究中，许多患者的检测未遵循标准建议，这给我们的医疗保健系统带来了经济和基于价值的负担。因此有必要提高临床医生的认识，以确保高价值医疗。
