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 |