Prothrombin Time and Activated Partial Thromboplastin Time Testing: A Comparative Effectiveness Study in a...

Area of Science:

• Medical Diagnostics
• Health Services Research
• Evidence-Based Medicine

Background:

• A significant portion of healthcare spending may be wasted on non-evidence-based practices.
• The study investigated the utilization of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) tests in preoperative patients for potential waste and lack of evidence.

Purpose of the Study:

• To characterize the use of preoperative PT and aPTT tests.
• To identify potentially wasteful and non-evidence-based testing practices.

Main Methods:

• Analysis of prospectively collected data from 1,053,472 patients undergoing elective surgery across 27 US institutions (2009-2012).
• Evaluation of a subset of 682,049 patients with available test results and history and physical (H&P) records.
• Definition of unnecessary tests based on the absence of specific clinical indications for bleeding risk.

Main Results:

• 26.2% of preoperative patients received PT tests, with 94.3% deemed unnecessary based on H&P.
• 23.3% of preoperative patients received aPTT tests, with 99.9% deemed unnecessary based on H&P.
• Among patients without bleeding risk indicators, 6.6% of PT and 7.1% of aPTT tests were positive, suggesting misuse as screening tools.

Conclusions:

• Preoperative PT and aPTT tests are often used unnecessarily, functioning as screening rather than diagnostic tests.
• The widespread use of these tests without evidence-based indications raises concerns about healthcare costs and the impact of false positive results.