Thrombophilia Testing in Provoked Venous Thromboembolism

Gupta, Arjun; Sarode, Ravindra; Nagalla, Srikanth

doi:10.1001/jamainternmed.2017.1815

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Only 1 case mentioned social consequences. Table 2 provides examples of negative consequences in each domain from cases in our sample …”

Section: Resultsmentioning

confidence: 99%

“…Table 2 provides examples of negative consequences in each domain from cases in our sample. [33][34][35][36][37][38] Physical harms were depicted with greater detail than other consequences and often dominated case reports. Physical problems were typically described at length in precise clinical language, such as "[The patient] presented with acute-onset confusion, wordfinding difficulty, and short-term memory defects," 7(p1271) and "He pulled out his urinary catheter, causing severe trauma evidenced by profuse gross hematuria."…”

Section: Map Verification and Characteristics Of Case Descriptionsmentioning

confidence: 99%

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Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

et al. 2018

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“…Only 1 case mentioned social consequences. Table 2 provides examples of negative consequences in each domain from cases in our sample …”

Section: Resultsmentioning

confidence: 99%

Section: Map Verification and Characteristics Of Case Descriptionsmentioning

confidence: 99%

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

et al. 2018

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“…The American College of Physicians (ACP) and American Society of Hematology (ASH) recommend against routine screening for hypercoagulable state in the setting of acute thrombosis because the protein levels are altered and interpretation of test results become difficult 16 17. However, genetic mutation analysis as those done to detect Factor V Leiden mutation and prothrombin mutation are unaffected.…”

Section: Discussionmentioning

confidence: 99%

“…However, genetic mutation analysis as those done to detect Factor V Leiden mutation and prothrombin mutation are unaffected. Its is also interesting to note that both ACP and ASH recommend against screening for hypercoagulable states because a positive result need not predict the risk of recurrence risk 16 17…”

Section: Discussionmentioning

confidence: 99%

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

et al. 2019

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Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

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“…Second, the presence of an abnormal test result does not necessarily predict the risk of VTE recurrence and is not helpful for risk stratification [11]. Once treatment with anticoagulation is initiated, the outcome of these patients is no different than in those without thrombophilia [10, 12–15]. Third, there have been no prospective trials evaluating anticoagulation strategies for primary prevention in patients with inherited thrombophilias and current society guidelines recommend against this [16–18].…”

Section: Introductionmentioning

confidence: 99%

Thrombophilia testing in the inpatient setting: impact of an educational intervention

Kwang

Mou

Richman

et al. 2019

BMC Med Inform Decis Mak

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Background Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients. Methods During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention. Results Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering ( p = 0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls. Conclusion A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices. Electronic supplementary material The online version of this article (10.1186/s12911-019-0889-6) contains supplementary material, which is available to authorized users.

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Thrombophilia Testing in Provoked Venous Thromboembolism

Cited by 6 publications

References 7 publications

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

Thrombophilia testing in the inpatient setting: impact of an educational intervention

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