Background: Thrombophilia testing (TT) generally has a limited role in the management of patients with thrombosis in the inpatient setting. Inaccuracies with testing following acute thromboses or anticoagulation can lead to patient anxiety, inappropriate prolongation of anticoagulation, or false reassurance. Indiscriminate TT also adds to cost of healthcare for thrombosis.
Aims: To analyze the prevalence and cost of inpatient TT and investigate whether the results of these tests changed management.
Methods: This was a retrospective analysis at the University of Louisville Hospital from 7/1/2020 to 12/30/2020. Patients were included if they were admitted with thrombosis (arterial and/or venous) and underwent inpatient TT (any test as listed in Table 1). Chart review was done to study demographics, details of TT, and any subsequent change in management. Based on available evidence and guidelines [Baglin 2010, Van Cott 2002, Pengo 2009, Nicolaides 2005], the rate of inappropriate TT was assessed. Cost data were obtained from Clinical Laboratory Fee Schedule.
Results: Over the 6-month period, TT included 156 tests in 38 patients (average 4.1 tests/patient). The majority was female (63%) with a mean age of 48.3 years [range: 19-75]. The reasons for TT are detailed in Table 2; recurrent VTE was the most common. Two-thirds of TT (67%) were classed as inappropriate. Overall, 6 tests were positive (3.8%); none of the positive tests changed management. The total cost of TT was estimated at $38,944; inappropriate TT was estimated at $28,165.
|Test name||Number ordered||Number resulting positive||Test name contd.||Number ordered||Number resulting positive|
|Protein C activity||6||1||JAK2 mutation||8||0|
|Protein S activity||6||2||PNH flow cytometry||8||0|
|Antithrombin III activity||10||1||Lupus anticoagulant||17||0|
|Factor V Leiden mutation||19||0||dRVVT||17||0|
|Factor V activity||7||0||Beta-2 glycoprotein 1 Antibody (IgA/ IgG/ IgM)||17||1|
|Prothrombin mutation||16||0||Anti-cardiolipin Antibody (IgA/ IgG/ IgM)||18||1|
|TOTAL||156 tests||6 positive tests|
|Recurrent Venous Thromboembolism (VTE)||21 (55%)|
|VTE in an unusual location (cerebral, splanchnic)||11 (29%)|
|Stroke at a young age or recurrent cryptogenic stroke/arterial thrombosis||3 (7%)|
|Massive Pulmonary embolism||1(2%)|
|Pulmonary embolism in pregnancy||3(7%)|
Conclusions: Inpatient TT at an urban tertiary hospital was expensive (average estimate $1,024 per patient) with a high rate of inappropriate TT, low positive result rate (3.8%), and no change in management. We plan to implement interventions to improve this. The data suggest a role for systems-based hematology in the inpatient setting to improve the quality and value of care to patients admitted with thrombosis.
To cite this abstract in AMA style:Bandikatla S, Dadlani A, Pinter A, Maharaj S, Rojan A. Inpatient Thrombophilia Testing – Adding Unnecessary Cost to the Clot? [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/inpatient-thrombophilia-testing-adding-unnecessary-cost-to-the-clot/. Accessed September 24, 2021.
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