Retrospective Review of the Impact of Performing Triage on Hypercoaguability Tests

Background : Multiple studies have shown that anticoagulant medications affect special coagulation testing, causing interference in result interpretation. Potential harm from inaccurate results caused by anticoagulation could be prevented by proactively evaluating patient medication prior to testing. In our institution, special coagulation test requests are triaged by transfusion medicine physicians to ensure that interfering anticoagulant medications are not present. Aims : The aim of this study is to create guidelines for special coagulation testing in order to reduce the false positive rate. Methods : From December 2016 to December 2018, special coagulation triage was performed for all orders if one of the following criteria was met: PT \u3e 22, INR \u3e 2.0, PTT \u3e 43.5, or Thrombin \u3e 25. Based on current published literature describing the effects of direct oral anticoagulants, heparin, and warfarin on special coagulation testing, tests were cancelled if the patient was found to be taking an interfering anticoagulant. In special circumstances, special coagulation tests were approved despite anticoagulant presence. Results : A total of 1004 tests were triaged. 779 tests were cancelled and 225 were approved. Averaged over 2 years, cancelling special coagulation tests saved approximately $48,000 per year, using institutional pricing guidelines (Table 1). The cost of testing was then evaluated. Triage testing, factoring in phlebotomy cost, technical and professional time, was estimated at $9500 per year. Conclusions : Special coagulation testing on patients receiving anticoagulants can lead to false positive results, which can potentially cause inappropriate patient management. The calculated savings per year by cancelling such testing was substantial. Additional opportunities to save approximately $10,000 per year were identified if special coagulation testing was prevented from being ordered inappropriately. In collaboration with pharmacy, this initiative will reduce cost and potential harm to the patient as well as time spent researching anticoagulant use in the EMR by creating guidelines for clinicians ordering special coagulation tests. (Table Presented)