Inappropriate use of protein C, protein S, and antithrombin testing for hereditary thrombophilia screening: an experience from a large university hospital

Tientadakul, Panutsaya; Chinthammitr, Yingyong; Sanpakit, Kleebsabai; Wongwanit, Chumpol; Nilanont, Yongchai

doi:10.1111/j.1751-553x.2011.01332.x

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…In one study, 35.2% of patients were tested within 7 days of index VTE, and in another, 63% of abnormal PS and PC test results were attributed to concurrent anticoagulation therapy. 15,21,22 These observations raise concerns regarding the high likelihood of inaccurate results and their impact on the cost and management decisions for patients with VTE in our daily practice.…”

Section: Discussionmentioning

confidence: 99%

“…Repetition of any genetic testing was considered unjustified. Criteria for appropriateness of test repeats were based on the recommendations in the review articles by Nakashima and Rogers, Tientadakul et al, and Mahajerin et al 13,15,16 Given the uncertainty about the role of monitoring APLA titers in patients with established APS, we did not include the APLA panel in our analysis of appropriateness of repeated testing.…”

Section: Thrombophilia Testingmentioning

confidence: 99%

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Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism

Gaddh

Cheng

Elsebaie

et al. 2020

TH Open

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Introduction Testing for inherited and acquired thrombophilias adds to the cost of care of patients with venous thromboembolism (VTE), though results may not influence patient management. Methods This is a single-center, retrospective study conducted at Emory University Hospitals from January to December 2015 to (1) determine the pattern of thrombophilia testing in patients with VTE, (2) study the impact of results of thrombophilia testing on clinical decision-making, and (3) determine the direct costs of thrombophilia testing in patients with VTE. Results Of the 266 eligible patients, 189 (71%) underwent testing; 51 (26.9%) tested positive and the results impacted management in 32 (16.9%) of tested patients. Patient undergoing testing were more likely to be younger than 40 years (30.9 vs. 18.2%), have had prior pregnancy loss (9.0 vs. 0%), or known family history of hypercoagulability (24.9 vs. 10.4%), and were less likely to have had provoked VTE (37 vs. 79.2%). The most common thrombophilias tested were antiphospholipid syndrome (60.1%), factor V Leiden (59.7%), and prothrombin gene mutation (57.5%). Direct costs of thrombophilia testing were $2,364.32 per patient, $12,331.55 to diagnose 1 positive, and $19,653.41 per patient-management affected. Conclusion We noted significant variability in selection of patients and panel of tests, sparse utilization of test results in patient management, but high cost associated with thrombophilia testing in patients with VTE. With guidelines advocating selective use of thrombophilia testing and attention to potential impact of test results in patient management, we propose the need for measures at institutional levels to improve test-ordering practices.

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Section: Discussionmentioning

confidence: 99%

Section: Thrombophilia Testingmentioning

confidence: 99%

Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism

Gaddh

Cheng

Elsebaie

et al. 2020

TH Open

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“…[8][9][10] As PC activity often remains below the adult reference ranges until puberty, PC levels in childhood are hard to screen for inherited thrombophilias. 11 Several factors affect the physiological levels of PC and PS throughout childhood. 12 Both activities are low in the presence of vitamin K antagonist.…”

Section: Pc and Pc Levels In Childrenmentioning

confidence: 99%

Protein C deficiency as the major cause of thrombophilias in childhood

Ohga

Ishiguro

Takahashi

et al. 2013

Pediatrics International

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“…Sir, We read with great interest the article by Tientadakul et al [1] as it highlighted a problem common to thrombophilia testing in laboratories of South and South East Asian countries. Inappropriate patient selection and timing of tests for thrombophilic states can generate potentially misleading false-positive results, consumes economic and human resources and reduces laboratory efficiency in a resource-constrained setting.…”

Section: Laboratory Screening Of Thrombophilia Testing Requisitions Fmentioning

confidence: 99%

Laboratory screening of thrombophilia testing requisitions for adequacy/appropriateness and reduced abnormal results

Ahluwalia

Sharma

2012

Int J Lab Hematology

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Inappropriate use of protein C, protein S, and antithrombin testing for hereditary thrombophilia screening: an experience from a large university hospital

Abstract: To enhance the appropriate use of hereditary thrombophilia screening tests, physician education concerning the patient selection, suitable timing for testing and repetition of the tests with abnormal results should be emphasized.

Cited by 10 publications

References 36 publications

Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism

Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism

Protein C deficiency as the major cause of thrombophilias in childhood

Laboratory screening of thrombophilia testing requisitions for adequacy/appropriateness and reduced abnormal results

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