Presentation Details

SPLTRAK Abstract Submission
Recognizing reasons of unwarranted coagulation testing in medically ill patients – a sneak peek
Sidra Asad Ali, Amir Khan, Naila Noor
Patel Hospital, Karachi, Pakistan

BACKGROUND: Laboratory tests for hemostasis are among the most common diagnostic tests in medically ill patients. At the same time these test are poorly understood by clinicians and often ordered indiscriminately for all admitted patients. Unwarranted testing is not only expensive and cause gratuitous blood sampling but also adds burden to laboratory staff wasting technical resources. OBJECTIVES: The primary objective of the study was to determine reasons why PT/INR and aPTT tests were being frequently ordered in medically ill patients. The secondary objective was to identify the proportion of coagulation screening tests requested for appropriate indications and to recognize the clinical areas requesting irrational coagulation test. METHODS: Study was conducted in tertiary care center over one-year period from July 2018 – June 2019. A retrospective medical chart review was performed of all adult patients who were admitted in medicine wards and for any reason whose physician requested prothrombin time, activated partial thromboplastin time, or International Normalized Ratio. Appropriateness of test was determined by hematologist and internist using a novel algorithm developed by our institution. RESULTS: During study duration, 2314 patients were admitted in various sub specialties of medicine. Basic coagulation screening tests were ordered for 1544 (66.7%) of these patients. The mean age of the study set was 4312 years and 69% (n=1069) of these patients were male. Common indication found for coagulation test request are listed in table 1. In 58.2% (n=899) no appropriately indication of coagulation testing was found. Most irrational requests were received from general medicine section (26.6%, n=412) followed by cardiology (23.0%, n=356). CONCLUSION: Majority of coagulation tests are requested for inappropriate clinical indications. We hypothesized it might be due to an unfamiliarity with coagulation tests. A re-audit is planned after instituting clear guidelines to promote the appropriate use of PT and PTT tests in medically ill patients.