Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Hicks, Lisa K.; Rajasekhar, Anita; Bering, Harriet; Carson, Kenneth R.; Kleinerman, Judith; Kukreti, Vishal; Ma, Alice; Mueller, Brigitta U.; O’Brien, Sarah H.; Pasquini, Marcelo C.; Sarode, Ravindra; Wood, William A.

doi:10.1002/ajh.24412

Cited by 9 publications

(7 citation statements)

References 68 publications

(69 reference statements)

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“…The American Society of Hematology (ASH) has been an active participant in the Choosing Wisely initiative, with campaigns completed in 2013 and 2014 that resulted in 10 hematologic tests and treatments that health care providers should question 2,3 . Furthermore, in 2016, the ASH Choosing Wisely Task Force developed a methodology to identify and prioritize 10 Choosing Wisely recommendations from other medical societies that would be of high relevance and importance to patients with blood disorders and their health care providers 4 . In 2019, ASH and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a joint panel to solicit, evaluate, and select items for a pediatric hematology–focused Choosing Wisely list.…”

Section: Introductionmentioning

confidence: 99%

The ASH‐ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question

O’Brien

Badawy

Rotz

et al. 2021

Pediatric Blood & Cancer

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Choosing Wisely is a medical stewardship and quality‐improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The American Society of Hematology (ASH) has been an active participant in the Choosing Wisely project. In 2019, ASH and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a joint task force to solicit, evaluate, and select items for a pediatric‐focused Choosing Wisely list. By using an iterative process and an evidence‐based method, the ASH‐ASPHO Task Force identified 5 hematologic tests and treatments that health care providers and patients should question because they are not supported by evidence, and/or they involve risks of medical and financial costs with low likelihood of benefit. The ASH‐ASPHO Choosing Wisely recommendations are as follows: (1) avoid routine preoperative hemostatic testing in an otherwise healthy child with no previous personal or family history of bleeding, (2) avoid platelet transfusion in asymptomatic children with a platelet count 10 × 103/μL unless an invasive procedure is planned, (3) avoid thrombophilia testing in children with venous access‐associated thrombosis and no positive family history, (4) avoid packed red blood cells transfusion for asymptomatic children with iron deficiency anemia and no active bleeding, and (5) avoid routine administration of granulocyte colony‐stimulating factor for prophylaxis of children with asymptomatic autoimmune neutropenia and no history of recurrent or severe infections. We recommend that health care providers carefully consider the anticipated risks and benefits of these identified tests and treatments before performing them.

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Section: Introductionmentioning

confidence: 99%

The ASH‐ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question

O’Brien

Badawy

Rotz

et al. 2021

Pediatric Blood & Cancer

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“…7 The Joint Commission and American Society of Hematology have targeted RBC transfusions as one of the most overused procedures in the US hospitals. 8 Although data and guidelines pertaining to plasma utilization are limited, plasma use historically follows RBC transfusion trends. 4,9,10 By contrast, this study demonstrated a national increase in cryoprecipitate utilization.…”

Section: Resultsmentioning

confidence: 99%

Blood transfusion trends in the United States: national inpatient sample, 2015 to 2018

et al. 2021

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Blood transfusions are among the most common therapeutic procedures performed in hospitalized patients. This study evaluates contemporary national trends in RBC, plasma, platelet and cryoprecipitate transfusions. National Inpatient Sample (NIS), the largest all-payer inpatient database representing 94-97% of US population, was evaluated from the 4th quarter of 2015 through 2018. Quarterly trends for the percentage of hospitalizations with a transfusion procedure were separately examined for each blood product using log binomial regression and reported as quarterly percent change (QPC). The percentage of hospitalizations with a RBC transfusion decreased from 4.22% (2015Q4) to 3.79% (2018Q4) (QPC=-0.72[95%CI=-1.26, -0.19]; Ptrend=0.008). While plasma transfusions also decreased QPC=-1.33(95%CI=-2.00, 0.65;Ptrend<0.001), platelet transfusions remained stable QPC=-0.13[95%CI=-0.99,0.73]; Ptrend=0.766). In contrast, hospitalizations with cryoprecipitate utilization significantly increased QPC=2.01(95%CI=0.57,3.44; Ptrend=0.006). Significant quarterly reductions in RBC transfusions were also seen among many -but not all- strata of sex, race/ethnicity, patient risk-severity, and admission type (elective versus non-elective). Despite significant declines in RBC transfusions among older adults, there were no significant changes among pediatric age-group (<18-years) and those 18-49 years. The decline in RBC and plasma transfusions suggests steady incorporation of robust evidence base showing safety of restrictive transfusions. Increased cryoprecipitate use may be reflective of wider adoption of hypofibrinogenemia management and hemostasis testing for coagulopathic patients.

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“…There is no evidence to support a strong association between thrombophilia and infertility. Thrombophilia testing in this setting may increase cost, with minimal potential benefit and lead to inappropriate use of anticoagulants with no proven benefit [28,29].…”

Section: Evidence-based Tenets Of Thrombophilia Screeningmentioning

confidence: 99%

Evolving paradigm in thrombophilia screening

Ashraf

Visweshwar

Jaglal

et al. 2019

Blood Coagulation &Amp; Fibrinolysis

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The role of genetic thrombophilia screening for identifying a hypercoagulable state in the management of venous thromboembolism. We searched MEDLINE and EMBASE from 1995 to 2017, the websites of the professional bodies including American Society of Hematology, British Society of Hematology, International Society of Thrombosis and Hemostasis, College of American Pathologists, American College of Medical Genetics, and American Society of obstetrics and gynecology for their clinical practice guidelines. We used search strategy terms – venous thromboembolism, inherited, thrombophilia, and hypercoagulable state. Thrombophilia screening does not alter management in pregnancy, infertility, recurrent miscarriages, in primary occlusive arterial syndromes, and for primary prevention in relatives of venous thromboembolism patients considering hormonal manipulation including oral contraceptives. Routine thrombophilia screening for identifying a hypercoagulable state is not indicated in venous thromboembolism, as it is only useful in a select group of patients. There is no difference in the treatment of venous thromboembolism in patients with or without an inherited hypercoagulable state.

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Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Cited by 9 publications

References 68 publications

The ASH‐ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question

The ASH‐ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question

Blood transfusion trends in the United States: national inpatient sample, 2015 to 2018

Evolving paradigm in thrombophilia screening

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