在中风或过渡性缺血性发作患者中遗传性血栓友病测试的低值:一项为期三年的回顾性研究
Shyam Majmundar1, Sameep Thapa2, Elan S Miller1
1Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
概括
在中风或TIA后的住院遗传性血栓友病检测是昂贵的,并且产生了许多错误的阳性结果. 积极的结果很少改变这些动脉缺血事件的临床管理.
科学领域:
- 神经学 神经学
- 血液学 血液学 血液学
- 临床病理学 临床病理学
背景情况:
- 住院遗传性血栓友病检测是有争议的,因为高成本和对临床管理的影响有限.
- 对于孤立的急性动脉缺血性中风或过渡性缺血性心脏病发作 (TIA) 的患者,这种测试的有用性尤其受到争议.
研究的目的:
- 评估住院患者遗传性血栓友病检测的订购模式和结果.
- 评估这项测试对单独的急性缺血性中风或TIA而没有并发性静脉血栓栓塞的患者的临床管理的影响.
主要方法:
- 2019年1月至2021年12月期间因急性缺血性中风或TIA入院的患者的回顾性分析.
- 查看图表以确定中风风险因素,遗传血栓性血栓症测试结果和随后的临床管理.
- 分析包括检测V因子Leiden,前列血G20210A变体,高血糖蛋白,PAI-1升高,以及蛋白C,S和抗血缺乏.
主要成果:
- 在249名被测试的患者中,42.2%至少有一个异常结果;然而,其中28%是边界和可能的错误阳性.
- 根据中风风险因素或年龄 (<50 vs. ≥50岁) 观察到的阳性测试概率没有显著差异.
- 对1035个订购的测试的总费用为468,588美元.
结论:
- 在隔离急性动脉缺血性中风或TIA之后的住院遗传性血栓症测试与可能的错误阳性和显著成本的高率有关.
- 阳性测试结果并没有导致研究患者的临床管理发生任何变化.
- 这些发现表明,常规的住院遗传性血栓友病检测可能对这种患者群体来说不具有成本效益或临床益处.
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