Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center

Figures & data

Table 1 Patient Demographics

Total Patients		287
Age		63.7 years
Gender
	Male	136 (47.4%)
	Female	151 (52.6%)
Race
	White	234 (81.5%)
	Black	80 (27.9%)
	Asian	9 (3.1%)
	Other	40 (14.0%)
BMI		29.71
Medical History
	Immobilization	55
	Hospitalization in last 3 months	80
	Malignancy	59
	Previous DVT	57
	Prolonged travel	26
	Chronic kidney disease	27
	Atrial fibrillation	34
	Inflammatory bowel disease	3
	Liver disease	1
	Heparin induced thrombocytopenia	3
	Antiphospholipid syndrome	1
	Cerebrovascular accident	14
	Surgery in past 3 months	31
	History of central line placement	6
	Present pregnancy	1
	Nephrotic syndrome	1
	Congestive heart failure	19
	PCOS	0
	PNH	0
	Warfarin induced skin necrosis	0
	History of recurrent abortions	0
	Substance abuse	14
	Diabetes mellitus	40
	Hypertension	136
	Coronary artery disease	38
	Chronic obstructive pulmonary disease	21
	Active malignancy	30
Family History
	Factor V mutation	4
	Prothrombin gene mutation	1
	Protein S deficiency	0
	Protein C deficiency	0
	Antithrombin III deficiency	0

Table 2 Criteria for “No Adherence” to Guidelines for Inherited Thrombophilia

Provoked VTE (Presence of Major Transient Risk Factor Like Surgery, Trauma or Prolonged Immobility)
1st episode of VTE, regardless of provoked v/s unprovoked
Active malignancy
Acute/active VTE
Active VTE treatment/Anticoagulation

Table 3 Relative Indications for Hypercoagulability Work-Up

Recurrent VTE/Prior History of VTE
Family history of hypercoagulable state
VTE at unusual sites
VTE at age <45 years

Figure 1 Suggested algorithm for determining the need for a hypercoagulability work-up.

Table 4 Cost Analysis

Type of Test	No. of Times Ordered	Current Price of Test	Total Cost
APC resistance/Factor V Leiden mutation	43	$241	$10,363
Prothrombin gene mutation	13	$237	$3081
Protein S deficiency	37	$180	$6660
Protein C deficiency	36	$231	$8316
Antithrombin deficiency	36	$226	$8136
			$36,556

Figure 2 Analysis of why the hypercoagulability work-up was ordered unnecessarily.

Figure 3 Analysis of relative indications present in patients who received thrombophilia work-up.