A New Approach for Pre Analytical Screening of Hospitalized Patients Receiving Anticoagulant Therapy

Abstract number: P1890

Katz B, Kirgner I, Zwang E, Vardimon H, Goncharov I, Mar-Zeev P, Deutsch V

Two common laboratory tests are heavily utilized for the primary screening of coagulation disorders and monitoring of anticoagulation treatment. Activated Partial Thromboplastin Time (aPTT) is used to measure the intrinsic coagulation pathway and monitor heparin therapy. Prothrombin Time (PT) tests the extrinsic coagulation system and used for monitoring oral anticoagulant treatment. Many clinical laboratories incorporate routine coagulopathy work-up on samples with extended PT/aPTT results. However, aberrant PT/aPTT results are the consequence of either anticoagulant therapy or a coagulopathy that should be identified. The aim of our study was to develop pre-analytical identification of patients receiving anticoagulant therapy. Two types of coagulation sampling tubes, containing identical Na-citrate concentrations were introduced in Tel Aviv Sourasky Medical Center departments and clinics. The common blue cap coagulation tube (for patients not receiving anticoagulation), and a second type of coagulation tube with light blue cap (for patient treated with anticoagulation) were introduced for identifying patients receiving anticoagulant therapy. Following a period of education and use of this system, we examined compliance of internal medicine departments for performing coagulation tests sampling. Screening of 152 routine coagulation samples of different internal medicine departments indicate 83.5% compliance with respect to proper coagulation sampling. The compliance ratios varied between 100% to 50% in different departments. Indicating reeducation of certain departments with further improve the compliance. Of the inappropriate coagulation tube sampling, 16.5% of all samples sent to the laboratory, 64.3% were of patients receiving anticoagulants collected in normal (blue cap) coagulation tubes and 37.5% were of patients receiving no anticoagulation that were collected in tubes designated for patients receiving anticoagulant therapy. The usage of anticoagulant therapy designated tubes may increase the accuracy of coagulopathy diagnosis in hospitalized patients, and significantly improve the efficiency and cost-effectiveness in clinical laboratories by eliminating coagulation work-up of patients receiving anticoagulants.