Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland.
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Thromb Res. 2023 Mar;223:87-94. doi: 10.1016/j.thromres.2022.12.001. Epub 2022 Dec 15.
The collected evidence on thrombophilia guidelines is scarce and data about their impact on clinical decisions are unknown. We aimed to investigate the adherence to thrombophilia testing guidelines, its therapeutic impact in patients with guideline-adherent and non-adherent testing and identify the patients' clinical characteristics mostly associated with treatment decisions.
We conducted a single-center cross-sectional study of patients referred for thrombophilia testing at the outpatient clinic of a tertiary hospital between 01/2010-10/2020. We systematically evaluated the adherence of thrombophilia testing to internal guidelines and the influence of test results on anticoagulation therapy. Using multivariable logistic regression, we evaluated the association between clinical characteristics and influence of thrombophilia tests on anticoagulation therapy in the entire cohort and by indication for referral.
Of 3686 included patients, mostly referred for venous thromboembolism (2407, 65 %) or arterial thrombosis (591, 16 %), 3550 patients (96 %) underwent thrombophilia testing. Indication for testing was according to guidelines in 1208 patients (33 %). Test results influenced treatment decisions in 56 of 1102 work-ups (5.1 %) that were adherent to guidelines, and in 237 of 2448 (9.7 %) non-adherent work-ups (absolute difference, 4.3 %; 95 % confidence interval, 2.9-6.3 %). Age < 50 years, female sex, absence of risk factors and co-morbidities, weakly provoked venous thromboembolism and referral indication other than venous thromboembolism were associated with influence on anticoagulation therapy.
Adherence to guidelines for thrombophilia testing was poor and did not have an impact on treatment decisions. Refinement of selection criteria is needed to increase the therapeutic impact of thrombophilia testing.
关于血栓形成倾向指南的现有证据有限，关于其对临床决策影响的数据尚不清楚。我们旨在调查血栓形成倾向检测指南的遵循情况，以及其在遵循和不遵循检测指南的患者中的治疗效果，并确定与治疗决策最相关的患者临床特征。
我们进行了一项单中心、回顾性研究，纳入了 2010 年 1 月至 2020 年 10 月在一家三级医院门诊因血栓形成倾向检测而就诊的患者。我们系统地评估了血栓形成倾向检测对内部指南的遵循情况，以及检测结果对抗凝治疗的影响。使用多变量逻辑回归，我们评估了整个队列以及根据转诊指征的情况下，患者临床特征与血栓形成倾向检测对抗凝治疗的影响之间的关系。
在 3686 例纳入的患者中，大多数因静脉血栓栓塞（2407 例，65%）或动脉血栓形成（591 例，16%）而就诊，其中 3550 例（96%）患者接受了血栓形成倾向检测。1208 例（33%）检测是根据指南进行的。在 1102 例符合指南的检测中，有 56 例（5.1%）检测结果影响了治疗决策，在 2448 例不符合指南的检测中，有 237 例（9.7%）检测结果影响了治疗决策（绝对差异，4.3%；95%置信区间，2.9-6.3%）。年龄<50 岁、女性、无风险因素和合并症、轻度诱发的静脉血栓栓塞以及除静脉血栓栓塞以外的转诊指征与抗凝治疗的影响相关。
血栓形成倾向检测指南的遵循情况较差，且并未对治疗决策产生影响。需要进一步完善选择标准，以提高血栓形成倾向检测的治疗效果。
