PB0960 - Adherence to thrombophilia testing guidelines and accuracy of thrombophilia work-up: a single-center cross sectional study

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Kristina Vrotniakaite-Bajerciene, MD

Resident
Bern University Hospital
Bern, Bern, Switzerland

Co-Author(s)

FS

Fabienne Schmidli

Physician
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
KJ

Katarzyna Aleksandra Jalowiec

Hematologist
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
HB

Helen Broughton

Medical student
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
JS

Jenny Sarah Schneider

Hematologist
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
AH

Alan Haynes

Statistician
Bern University, CTU Bern
Bern, Bern, Switzerland
JB

Justine Brodard

Master of biomedical sciences
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
AR

Alicia Rovo

Hematologist
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland
JK

Johanna A. Kremer-Hovinga

Professor
Centre of Laboratory Medicine Section Hemostasis Inselspital Bern
Bern, Bern, Switzerland
AA

Anne Angelillo-Scherrer

Physician-in-Chief
Bern University Hospital, Department of Hematology and Central Hematology Laboratory
Bern, Bern, Switzerland

Background: Selective thrombophilia testing has been introduced to clinical practice in 2010 considering low clinical utility of systematic thrombophilia testing. Although guidance adherence and accuracy of thrombophilia testing has been proven to be poor in acute or general hospital care, it has not been assessed in an outpatient specialized center yet.

Aims: To examine the adherence to thrombophilia testing guidance and accuracy of work-up at a tertiary thrombophilia center.

Methods: We conducted a single-center cross sectional study of 3686 patients referred to the thrombophilia consultation, at the Bern University Hospital (Switzerland), from 01/2010 to 10/2020. We studied the adherence to indication of thrombophilia testing according to international and internal guidelines at a specialized thrombophilia center and evaluated the accuracy of thrombophilia work-up.

Results: Thrombophilia testing was performed in 3550 patients (94%) and 1258 patients (28.9%) displayed at least one thrombophilia. Most of the included patients (2407, 65%) were referred because of venous thromboembolism (VTE) and arterial thromboembolism (591, 16%), followed by asymptomatic patients (567, 15%) and pregnancy morbidity (121 patients, 3%).

Only 1208 work-ups (33%) were adherent to the guidance of the thrombophilia center, mostly in asymptomatic patients (Table 1). Significantly more positive results for heterozygous and homozygous factor V Leiden mutation and protein S deficiency were found in patients tested not according to internal and international guidance (Table 2).

Three thousand three hundred nineteen thrombophilia work-ups (3319, 95.6%) were accurate, whereas 79 (2.3%) were performed inappropriately on anticoagulation and 59 (1.7%) on contraceptive treatment or in pregnancy.

Conclusion(s): Our study shows very good accuracy of thrombophilia work-up but poor adherence to thrombophilia testing guidelines at a specialized thrombophilia center in Switzerland. A more standardized and simpler approach to thrombophilia work-up is needed.