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Table 2 Criteria Used to Determine Appropriateness of Test Ordering

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

Inappropriate Ordering
Patient characteristics
Provoked VTE occurring in the setting of major transient risk factor
Women with pregnancy-related VTE
Patients with advanced liver disease and abnormal function
Ordering factor V Leiden or prothrombin gene mutation in patients who have had a liver transplant (no correlation between patient’s DNA and factor status produced by the new liver)
Testing for the MTHFR polymorphism (obsolete test, does not correlate with risk of VTE)
Timing issues
Ordering antithrombin III, protein C or S level during the first 3 months of anticoagulant therapy
Ordering protein C or S levels during warfarin therapy, or within 2 weeks of stopping warfarin
Ordering lupus anticoagulant, antithrombin III, protein C or S levels in patients on novel oral anticoagulants
Duplicate ordering of heritable thrombophilias: factor V Leiden, prothrombin gene mutation, JAK2 V167F mutation).
Ordering of heritable thrombophilia workups (FV Leiden, Prothrombin gene mutation, and protein C/S levels) in the inpatient setting, if fails to impact clinical management decisions.
Appropriate Ordering
Patients with unprovoked VTE in whom test results may impact duration or choice of anticoagulant (e.g. positive antiphospholipid antibody screening)
Patients with VTE and multiple family members with history of VTE (higher risk of thrombophilia such as AT3 deficiency)
Thrombosis at unusual sites (e.g. splanchnic, Budd-Chiari, renal, or cerebral venous thrombosis)
Recurrent provoked VTE
Screen for antiphospholipid antibody in the setting of recurrent pregnancy loss (we can define further)
Unexplained arterial thromboses
Ordering antiphospholipid antibody testing in the setting of arterial thrombosis (e.g. peripheral arterial events, CVA)
Unclear Ordering
Female patients who develop VTE on hormonal therapy
Patients with upper extremity DVT
Testing ordered at the patient’s request
VTE with minor risk factor (e.g. travel-related or flight < 6-8 h, minor surgery, prolonged sitting, etc.)
VTE in young patients with stroke and PFO