Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
Division of Hematology-Oncology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
PLoS One. 2021 Sep 20;16(9):e0257687. doi: 10.1371/journal.pone.0257687. eCollection 2021.
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.
在住院环境中，通常不进行血栓形成倾向检查，因为检查可能会因抗凝、急性血栓形成或急性疾病而产生偏差。
确定住院患者血栓形成倾向检查与机构指南的一致性。
这是一项回顾性研究，评估了 2019 年在 Lehigh Valley Hospital at Cedar Crest 因静脉血栓栓塞或缺血性卒中住院的成年患者的血栓形成倾向检查情况。检查包括遗传性和获得性血栓形成倾向。单独查阅患者病历，以评估以下三个测量结果：1）住院环境中适当的血栓形成倾向检查数量；2）血栓形成倾向检查的指征；3）改变临床管理的阳性血栓形成倾向检查比例。
本研究共纳入 201 例患者。26 例（13%）患者按照机构指南进行了适当的检查，175 例（87%）患者进行了不适当的检查。不适当检查的最常见原因是在急性血栓形成期间进行检查。201 例患者中有 28 例检测出阳性血栓形成倾向，但审查员仅注意到 7 例患者的临床管理发生变化——涉及抗凝药物改变。
我们的研究表明，大多数住院患者的血栓形成倾向检查不符合适当检查的机构指南，也未改变患者的管理。这些血栓形成倾向检查通常被过度使用，在住院环境中几乎没有临床意义。
