[2006] Utility of Thrombophilia Testing in the Reproductive Setting

Sanjita Ravishankar, Lucia R Wolgast, Kafui Demasio, Jacob H Rand. Montefiore Medical Center, Bronx, NY

Background: The rising cost of healthcare has led to closer scrutiny of the utilization of laboratory testing. Specialized coagulation and molecular tests for thrombophilias, the average cost of which is approximately $1500, are often ordered in the evaluation of pregnancy complications, such as repeated pregnancy losses (RPL), intrauterine fetal demise (IUFD) and pre-eclampsia. Guidelines on appropriate indications have been published by various organizations, including ACOG, ACCP, BSH and ISTH. The objective of this study was to assess the “real world” utilization of thrombophilia testing in the reproductive setting at a large, urban tertiary care academic center and compare this with published guidelines.
Design: The results of 351 nonconsecutive thrombophilia studies in the reproductive setting from 2009-2012 were reviewed and correlated to clinical indications found upon chart review. Indications were categorized as consistent or inconsistent with recommendations as defined by review of consensus guidelines in hematologic and obstetric literature, which generally limit testing to patients with RPL or a personal or family history of thromboembolism.
Results: A total of 2100 tests were reviewed, the results of which are shown in Table 1. Interestingly the likelihood of finding an abnormality was not significantly different between groups. To our knowledge this is the largest study of the use of thrombophilia testing at a single center.

Table 1
 Consistent† Inconsistent‡  
 # Tested#/% Abnormal# Tested#/% Abnormal% Appropriate
Antithrombin III972/2%903/3%52%
Protein C1081/1%1002/2%52%
Protein S11732/27%11034/31%52%
Plasminogen150/0%90/0%63%
Activated Protein C Resistance922/2%754/5%55%
Lupus Anticoagulant1607/4%1759/5%48%
Antiphospholipid Antibody Screen12411/9%14714/10%46%
Factor V Leiden Mutation971/1%863/3%53%
Prothrombin G20210A Mutation1002/2%892/2%53%
MTHFR Mutation8431/37%8236/44%51%
Total1057101/10%1043123/12%50%
†Provoked DVT or PE, RPL, Family history ‡Unprovoked DVT or PE, primary infertility, isolated IUFD or SAB, pre-eclampsia, IUGR, preterm labor, ectopic pregnancy, abruption, other


Conclusions: We determined that 50% of thrombophilia tests are ordered for indications that are inconsistent with published guidelines, indicating a significant mismatch between the literature and clinical setting. Pathologists need to investigate the reasons behind this mismatch and coordinate with clinicians on reviewing and modifying recommendations for appropriateness, which will likely result in major health care savings.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 302, Tuesday Morning

 

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