The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question

Abstract

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 ASH is an active participant in the Choosing Wisely ® project. Using an iterative process and an evidence-based method, ASH has identified 5 tests and treatments that in some circumstances are not well supported by evidence and which in certain cases involve a risk of adverse events and financial costs with low likelihood of benefit. The ASH Choosing Wisely ® recommendations focus on avoiding liberal RBC transfusion, avoiding thrombophilia testing in adults in the setting of transient major thrombosis risk factors, avoiding inferior vena cava filter usage except in specified circumstances, avoiding the use of plasma or prothrombin complex concentrate in the nonemergent reversal of vitamin K antagonists, and limiting routine computed tomography surveillance after curative-intent treatment of non-Hodgkin lymphoma. We recommend that clinicians carefully consider anticipated benefits of the identified tests and treatments before performing them.

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

“…All ABIM CW recommendations posted on the ABIM CW website [5] were compiled at the end of April, 2015. At that time, there were 65 participating professional societies (excluding ASH) contributing 5-15 recommendations each, for a total of 380 individual recommendations.…”

“…The American Society of Hematology (ASH) has previously released two lists of Choosing Wisely recommendations [5,6]. In 2015, the ASH CW Task Force developed a methodology to systematically identify and prioritize CW recommendations from other professional societies of relevance and importance to the practice of hematology.…”

Five hematologic tests and treatments to question

“…3 Systematic reviews of the literature were then completed for each of the 10 semifinalist items using the same methods described previously. 2 A professional methodologist (A.E.H.) reviewed all titles and abstracts for potential inclusion.…”

“…The list included items addressing thrombophilia testing, general RBC transfusion practices, plasma utilization for vitamin K antagonist reversal, inferior vena cava filter use for acute venous thromboembolism (VTE), and surveillance CT scans after successful treatment of aggressive lymphoma. 2 This article reports the methods and results of ASH's second Choosing Wisely ® campaign.…”

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

“…While the overall use of red cells is decreasing in many countries, large audits show much inappropriate use (up to 50%) [11] and considerable inter-institutional variability (ranging from 7.5 to 98 percent transfusion rates in cardiac surgery) [12]. Recently, multiple societies have endorsed recommendations from the Choosing Wisely Campaigns [13][14][15][16] that include avoiding transfusion for arbitrary hemoglobin (Hb) thresholds in the absence of symptoms of active coronary disease, heart failure or stroke, and not performing repetitive CBC and chemistry testing in the face of clinical and lab stability.…”