Thrombophilia testing in young patients with ischemic stroke

Pahus, Sidse Høst; Hansen, Anette Tarp; Hvas, Anne‐Mette

doi:10.1016/j.thromres.2015.11.006

Cited by 39 publications

(33 citation statements)

References 27 publications

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“…We found that the majority of tests were ordered for venous thromboses; patients with unprovoked venous thromboses need to be on anticoagulation regardless of the test results, and therefore testing is not indicated in the inpatient setting. For patients with an unprovoked arterial thrombosis, a change in management may occur from antiplatelet to anticoagulation and testing is thus appropriate [1,5,6]. In the acute inpatient setting, it is recommended to check the anti-phospholipid panel (beta2 glycoprotein antibody, the aCL antibody, and LA (if the patient is not on anticoagulation), as these tests are not affected by acute thromboses and thus are appropriate to order [1,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…For patients with an unprovoked arterial thrombosis, a change in management may occur from antiplatelet to anticoagulation and testing is thus appropriate [1,5,6]. In the acute inpatient setting, it is recommended to check the anti-phospholipid panel (beta2 glycoprotein antibody, the aCL antibody, and LA (if the patient is not on anticoagulation), as these tests are not affected by acute thromboses and thus are appropriate to order [1,5,6]. For example, in a patient who developed a stroke and is not on anticoagulation and is found to be antiphospholipid antibodies positive, the management would change to anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…The American Society of Hematology recommends against routine ordering thrombophilia tests, especially in the setting of major transient risk factors that can skew the results [3]. As per expert opinion, thrombophilia testing for any indication other than unprovoked arterial thrombosis is unnecessary in the inpatient setting [1,5,6]. Thus, it would only be ideal to order the antiphospholipid panel in a patient with stroke when it will lead to a change in the management from antiplatelet to anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

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Hypercoagulable workup in a community hospital setting: to test or not to test; that is the question

Gupta

Patel

Anwar

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Thrombophilia tests are often ordered unnecessarily and/or inappropriately, with significant impact on healthcare costs, hospital resources, time, and potential harm to the patient.Objective: To identify the incidence of unnecessary and inappropriate thrombophilia testing in a community hospital setting.Methods: We retrospectively reviewed electronic medical records for patients who underwent inpatient thrombophilia testing at The Brooklyn Hospital Center from 1/1/2018 to 12/31/2018. The indications, and details of the tests, and associated costs were recorded.Results: A total of 62 patients were included (mean age 45.8, 67.7% female). In 57/62 (91.9%) patients, tests were ordered in the acute phase of thrombosis. At the time the tests were ordered, 29/62 (46.8%) patients were on anticoagulation. Positive results were found in 21/62 (53.2%) patients, but was repeated in only 1/21 (4.7%) patient. Results for 51/62 (82%) patients were obtained after discharge. The hematology-oncology service was consulted in 5/62 (8.1%) cases and recommended testing in only 1 (1.6%) patient. Only 1 (1.6%) patient had both an appropriate indication and appropriate testing. Costs for the 273 total tests were $26,400.Conclusion: Thrombophilia tests were often ordered inappropriately and unnecessarily. We recommend testing only for patients with inpatient status under recommendation from the hematology-oncology service.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypercoagulable workup in a community hospital setting: to test or not to test; that is the question

Gupta

Patel

Anwar

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…Ðios me ta a na li zës duo me ni mis, an ti-b2-gli kop ro tei no 1 an ti kûnø (an ti-b2GP1) nu sta ty mas taip pat bu vo su si jaes su pa didë ju sia ið emi nio in sul to ri zi ka, o ry ðys tarp an ti kar dio li pidi niø an ti kû nø (AKA) ir ið emi nio in sul to ne bu vo ras tas. Ki ta me at lik ta me ty ri me nu sta ty ta, kad LA per si sta vi mas pa di di na ið emi nio in sul to ri zi kà, o ry ðio tarp an ti-b2GP1 ir ce reb ro vas ku li nio ávy kio ne nu sta ty ta [31]. Ki ti au to riai skirs to AFA pa gal trom bo zi nio ávy kio ri zi kà: "aukð tos rizi kos" AFA yra tei gia mas LA, "tri gu bas tei gia mu mas"tei gia mas LA, AKA ir an ti-b2GP1 ar ba per si stuo jan tys izo liuo ti AKA vi du ti niu-aukð tu tit ru.…”

Section: áGyta Trombofilijaunclassified

Thrombophilia in young adults with ischemic stroke: an overview

Mineikytė¹,

Kryžauskaitė²,

Ryliškienė³

2019

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Trombofilija yra būklė, didinanti trombozinių įvykių riziką. Hiperkoaguliaciniai sutrikimai gali turėti įtakos galvos smegenų infarkto etiopatogenezei. Nors tyrimų dėl trombofilijos nauda yra nežinoma, išeminį galvos smegenų infarktą patyrę jauno amžiaus pacientai vis dažniau tiriami dėl hiperkoaguliacinių sutrikimų. Tačiau, net ir diagnozavus juos, vis dar trūksta įrodymais pagrįstų gydymo rekomendacijų, todėl daugeliui pacientų antrinė galvos smegenų infarkto profilaktika nesikeičia. Šiame straipsnyje apžvelgti literatūros duomenys apie dažniausių trombofilijų ir jaunų žmonių galvos smegenų infarkto ryšį, paplitimą, diagnostiką, gydymą ir antrinę insulto prevenciją.

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“…In addition to conditions that predispose to VTE, some authors expand the definition to include conditions that predispose to arterial thrombosis as well. 23 The most restrictive definitions apply the term to hereditary disorders of the genes encoding proteins in the coagulation cascade and to antiphospholipid syndrome (APS). More expansive definitions can embrace a very large number of hereditary characteristics, diseases, and acquired conditions (►Table 1).…”

Section: Historical Aspectsmentioning

confidence: 99%

Thrombophilic Evaluation in Patients with Acute Pulmonary Embolism

Stevens

Ansell

2017

Semin Respir Crit Care Med

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Patients with acute pulmonary embolism (PE) are often tested for thrombophilias, which are hereditary and acquired conditions that predispose to thrombosis. If a hereditary condition is identified, then testing is often performed on members of the patient's family. Testing for these conditions can be complex, as the presence of acute thrombosis and antithrombotic therapies can make the results of many tests unreliable. Many risk factors for thrombosis exist that are not routinely assessed by laboratory testing, and it is likely that many hereditary thrombophilia conditions remain to be discovered. Also, various risk factors for thrombosis interact with one another. Therefore, the results of a laboratory thrombophilia evaluation provide a limited ability to assess a patient or family members' risk for future thrombosis, and such testing usually does not provide information that improves a management decision. Thrombophilia testing is expensive and carries potential risks. This article reviews common thrombophilias, their epidemiology and classification, and timing and technical aspects of accurate testing and provides rational suggestions for the use of thrombophilia testing in five clinical situations: (1) following provoked PE (or other venous thromboembolism), (2) following unprovoked venous thromboembolism, (3) in relatives of patients with thrombosis, (4) in female relatives of patients with thrombosis considering estrogen use, and (5) in female relatives of patients with thrombosis who are considering pregnancy. Published guidelines and guidance statements from professional societies and other groups are also reviewed. Clinicians should carefully consider the relevant risks and benefits before testing patients for thrombophilia. When performed, testing should be timed correctly and care should be taken to properly interpret results. New models that incorporate multiple genetic and clinical markers may improve the utility of testing, but these await further research.

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Thrombophilia testing in young patients with ischemic stroke

Cited by 39 publications

References 27 publications

Hypercoagulable workup in a community hospital setting: to test or not to test; that is the question

Hypercoagulable workup in a community hospital setting: to test or not to test; that is the question

Thrombophilia in young adults with ischemic stroke: an overview

Thrombophilic Evaluation in Patients with Acute Pulmonary Embolism

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