inpatient thrombophilia test Restrictions
March 13, 2019- Evidence-based restrictions on inpatient testing for thrombophilia have been approved with the input and review of McLaren physician leaders at multiple levels: Reference Lab Task Force, Subsidiary HVC Teams, and the HVC Steering Committee.
WHY: Inherited thrombophilia refers to a genetic condition that predisposes to an increased risk of venous thromboembolism (VTE). This disorder is prevalent in approximately 7% of the population and the relative risk of VTE is 3- to 20-fold greater in patients with inherited thrombophilia compared with the general population. However, the available evidence suggests that testing for inherited thrombophilia is not recommended in most clinical settings.
Compelling reasons to avoid inpatient thrombophilia testing for patients with unprovoked VTE include:
- Many thrombophilia tests are inaccurate in the setting of acute VTE and/or anticoagulation
- Results of testing often do not influence management
- A positive test result may lead to unnecessary patient anxiety
- Testing may result in inappropriately prolonged anticoagulation courses or unnecessary involvement of inpatient consultants
- Inpatient testing is not cost effective.
WHAT: Implement a systems-based project to restrict inpatient thrombophilia testing. Project goals are to support appropriate timing and selection of thrombophilia testing and improve lab stewardship.
HOW: Multimodal approach to include three components:
- Education (HVC web site info, posters, pocket cards)
- Audit and feedback (HVC teams, attending physicians, hematology and pathology specialists)
- Clinical decision support interventions
- Pop-up alert when thrombophilia testing is ordered on inpatients
- Restricted, deemed-status or ‘masking’ of thrombophilia tests within order entry system as a future state
Inpatient Thrombophilia Testing Project Summary
Choosing Wisely Lists Focusing on Thrombophilia Testing
Don’t test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the setting of major transient risk factors (surgery, trauma or prolonged immobility).
Don’t order MTHFR genetic testing for the risk assessment of hereditary thrombophilia.
Don’t do an inherited thrombophilia evaluation for women with histories of pregnancy loss, intrauterine growth restriction (IUGR), preeclampsia and abruption.
Don’t routinely order thrombophilia testing on patients undergoing a routine infertility evaluation.