Thursday, April 28, 2005

Utilization of tests for hypercoagulability as observed at a reference laboratory

Brian R. Jackson, Shannon R. Swenson, and George M. Rodgers.

Laboratory testing for hereditary causes of hypercoagulability has changed markedly over the past decade.  Many clinicians may not be aware of the latest testing recommendations, and as a result may not be ordering tests appropriately.

To quantify the frequency of ordering patterns suggestive of over-, under-, and misutilization of laboratory tests.

Design:  We studied test orders submitted to a reference laboratory over a one year period, along with their associated results. 
Setting:  Reference laboratory serving several hundred academic and community medical centers as well as independent laboratory clients
Main outcome measure:  Proportion of orders which are suggestive of specific suboptimal ordering patterns

(Preliminary Results): 14% of orders for APC resistance were accompanied by a simultaneous order for V Leiden DNA.  Protein S testing and Protein C testing were both performed substantially more often than V Leiden testing.  We are in the process of analyzing the data by patient to determine the percentage of patients who receive Protein C, Protein S and/or ATIII testing in the absence of V Leiden testing.

A substantial proportion of patients being worked up for hereditary causes of hypercoagulability appear to not receive all appropriate tests and/or receive unnecessary tests.  A limitation of this study design is the lack of access to other clinical information about the patients.  Clinicians need better mechanisms, preferably at the point of care, to guide their use of esoteric laboratory tests.

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