Evaluation of thrombophilia testing in the inpatient setting: A single institution retrospective review.
Chun Ting Siu, Zachary Wolfe, Martin DelaTorre, Erafat Rehim, Robert Decker, Kathryn Zaffiri, Bradley Lash
Author Information
Chun Ting Siu: Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America. ORCID
Zachary Wolfe: Division of Hematology-Oncology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
Martin DelaTorre: Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America. ORCID
Erafat Rehim: Department of Neurology, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
Robert Decker: Division of Hematology-Oncology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
Kathryn Zaffiri: Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
Bradley Lash: Division of Hematology-Oncology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America.
BACKGROUND: Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness. OBJECTIVE: To determine adherence of inpatient thrombophilia testing with institutional guidelines. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
