Jan 12 2016
From Kelly Townsend, Tricore Laboratories, Albuquerque: We recently had a compliance audit and our consultant suggested that we should offer two separate panels for thrombotic risk; one for arterial and
one for venous. Are other labs offering two different hypercoagulable panels?
Thank you, Kelly. Participants, when you answer, please list the assays you offer as part of your arterial thrombosis profile. Thank you.
I am in complete agreement
I am in complete agreement with Emmanuel’s comments. I would also like to know what a “risk profile” or “panel for thrombotic risk” for either arterial or venous thrombosis consists of. If we are talking about testing prior to a thrombosis, then it seems to me that the major risk factors for both do not involve any coagulation tests at all (e.g. hyperlipidaemia, smoking, diabetes, hypertension, obesity for arterial thrombosis; and for venous thrombosis: age, previous VTE, surgery, fractures, contraceptives, pregnancy, immobility, prolonged travel.) Maybe some tests for hypercoagulability–but what should they be. Lupus anticoagulant testing might be helpful.
If we are talking about testing after the thrombosis then that is unlikely to help with the patient’s management and that is assuming that the testing is done at the appropriate time.
From Donna Castellone at New
From Donna Castellone at New York Presbyterian Medical Center: Where I currently work, we do not offer different profiles; it is straight forward coagulation testing. In a previous job, where there were a lot of coagulation consultations, we did offer two profiles, and the clinicians liked them. These were done on outpatients, where they were investigating patients for almost everything. In contrast, for inpatients, we also struggled with getting samples that were collected after an event, or while they were on heparin. All this did was provide poor results to clinicians, so in house patients could ONLY have testing if ordered/approved by a hematologist. This helped to curb ordering testing on patients where there was no benefit. The cause of thrombosis in this case doesn’t need to be known, just treated.
i would have to totally agree
i would have to totally agree with Dr. Favaloro on this one. The CAP consultant seems like they are trying to attempt to increase profit. I can’t find any literature on the subject. How was the idea for the distinction between arterial and venous thrombosis panel differences even conceived? What is the scientific basis in “real world” testing?
I guess if the aim is to make
I guess if the aim is to make more money, then we should be testing more patients for thrombophilic risk, but if the intention is to perform tests that may actually help patients, then thrombophilia is a condition where less is often best. I think we can do more tests when clinicians stop sending us samples after patients have had a thrombosis and are put on anticoagulant therapy. In these cases, which account for maybe 50% of current test requests, the chances of ‘diagnosing’ a false antithrombin deficiency, protein C deficiency, protein S deficiency, APC resistance or lupus anticoagulant, are about 10x the likelihood of diagnosing a true defect–so, here, less is best. If we extrapolate the case to ‘arterial’ thrombosis, what is the suggested panel, and what is the effect of these tests when patients are on medications? Is the suggestion to include platelet function testing, for example? Or maybe von Willebrand factor? And what is the expectation should ‘elevated’ activity be determined? Multiple meds? I think most of us are moving away from ‘routine thrombophilia testing,’ and I have doubts that any ‘arterial’ thrombotic panel will do any better.