Study: Common Costly Clot Test Has Few Benefits

There’s no need to search for inherited thrombophilia, authors say

At least a half billion dollars are spent each year on blood tests to see which hospital patients have a genetic quirk that makes their blood more likely to form dangerous clots. But most of that spending probably isn’t necessary, according to a new study by researchers at the University of Michigan Medical School.

Writing in the Journal of Hospital Medicine, the investigators review what is known about testing for inherited thrombophilia and call for a drastic reduction in the test’s use by physicians across the United States.

After all, they write, hospitalized patients who have already experienced a venous thromboembolism (VTE) don’t need a positive genetic test to justify taking medication and making other changes to prevent future events. And there is no evidence that medication to prevent clots will help hospital patients who haven’t yet had a VTE. Testing their DNA for inherited thrombophilia won't change that, the authors point out.

In other words, ordering inherited thromboembolism testing for inpatients is something doctors do for little or no reason. And according to the team’s analysis of data from medical records, they do it hundreds of thousands of times a year in Medicare patients alone.

“More testing is not always better,” said co-first author Christopher Petrilli, MD. “Testing for [inherited thrombophilia] is almost never beneficial and in fact can even be harmful because it can cause undue psychological distress for the patient and unnecessary expense for the health care system,” he adds.

“Physicians and patients should resist the temptation to perform a costly search for an underlying genetic cause of venous thrombosis,” echoed co-first author Lauren Heidemann, MD.

Drs. Petrilli and Heidemann have set out to address such “no reason” testing at their institution. They have co-founded a local chapter of Providers for Responsible Ordering that aims to help physicians, nurse practitioners, and physician assistants reduce over-testing and use health care resources appropriately.

Source: University of Michigan Health System; November 2, 2016.