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.

中文翻译：

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住院患者血栓形成倾向测试的评估：单一机构回顾性审查。


背景血栓形成倾向检查通常不适合住院患者，因为测试可能会因抗凝、急性血栓形成或急性疾病而出现偏差。目的 确定住院患者血栓形成倾向检测是否符合机构指南。患者和方法 一项回顾性研究，旨在评估 2019 年因静脉血栓栓塞或缺血性中风入住位于 Cedar Crest 的 Lehigh Valley 医院的成年患者的血栓形成倾向测试实践。测试包括遗传性和获得性血栓形成倾向。针对三个测量结果对患者图表进行单独审查：1）住院环境中适当的血栓形成倾向测试的数量； 2) 血栓形成倾向检测的适应症； 3) 血栓形成倾向测试阳性的比例随临床管理的变化而变化。结果 201 名患者被纳入我们的研究中。 26 名患者 (13%) 根据机构指南进行了适当的测试，175 名患者 (87%) 进行了不适当的测试。不适当测试的最常见原因是在急性血栓形成期间进行测试。 201 名患者中有 28 名血栓形成倾向测试呈阳性，但评审人员仅注意到 7 名患者的临床管理发生了变化，涉及抗凝治疗的改变。结论 我们的研究显示，大多数住院患者血栓形成倾向检测并未遵循适当检测的机构指南，也没有改变患者管理。这些血栓形成倾向测试常常被过度使用，并且在住院环境中的临床效用很小。