| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Medicine (Neurology), Duke University Medical Center, Durham, NC.
Address correspondence and reprint requests to Dr. L.B. Goldstein, Duke Center for Cerebrovascular Disease, Department of Medicine (Neurology), P.O. Box 3651, Durham, NC 27710; e-mail: Golds004{at}mc.duke.edu
OBJECTIVE: To investigate the use and appropriateness of specialized coagulation tests in the evaluation of patients with acute ischemic stroke and identify factors that influence test ordering.
BACKGROUND: Coagulation abnormalities are a rare but recognized cause of ischemic stroke.
METHODS: Patient demographics, stroke risk factors, history of venous thrombosis or miscarriage, family history of stroke, and the results of specialized tests for coagulation disorders were recorded for a consecutive series of ischemic stroke patients over age 18 admitted to an academic medical center over 3 years (n = 674). Factors associated with testing were identified with univariate analyses in a random sample of two-thirds of the patients (n = 450). Multivariate logistic regression modeling was then used to identify variables independently associated with testing and then validated in the remaining patients (n = 224).
RESULTS: Of the 31% of patients (n = 208) tested for coagulopathies, 29% (n = 60) were tested when the result was unlikely to influence therapeutic decisions. Historical factors associated with an increased incidence of a coagulopathy, such as history of venous thrombosis or miscarriage, were not commonly documented. The absence of small-artery atherosclerosis (OR 0.36, 95% CI 0.17 to 0.76) and younger age (OR 0.89 per year, 95% CI 0.87 to 0.92) were independently related to the frequency of specialized coagulation testing.
CONCLUSIONS: One-third of specialized coagulation tests were ordered when the test results were unlikely to affect therapeutic decisions. Age was the only clinical factor increasing the likelihood of a coagulopathy that appeared to influence ordering of specialized coagulation tests.
This article has been cited by other articles:
|
|
 |
|
  H. Ay, T. Benner, E. Murat Arsava, K. L. Furie, A. B. Singhal, M. B. Jensen, C. Ayata, A. Towfighi, E. E. Smith, J. Y. Chong, et al. A Computerized Algorithm for Etiologic Classification of Ischemic Stroke: The Causative Classification of Stroke System Stroke, November 1, 2007; 38(11): 2979 - 2984. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. F. Perkins JR and I. J. Butler Heart, Brain, and Mind: A Case Series of Multifactorial Ischemic Strokes in Children J Child Neurol, July 1, 2005; 20(7): 578 - 582. [Abstract] [PDF]
|
|
|
|
|
|
G. J. Hankey and J. W. Eikelboom Editorial Comment--Routine Thrombophilia Testing in Stroke Patients Is Unjustified Stroke, August 1, 2003; 34(8): 1826 - 1827. [Full Text] [PDF]
|
|
|
|
|
|
A. Pezzini, E. Del Zotto, M. Magoni, A. Costa, S. Archetti, M. Grassi, N. M. Akkawi, A. Albertini, D. Assanelli, L. A. Vignolo, et al. Inherited Thrombophilic Disorders in Young Adults With Ischemic Stroke and Patent Foramen Ovale Stroke, January 1, 2003; 34(1): 28 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Bushnell and L. B. Goldstein Homocysteine testing in patients with acute ischemic stroke Neurology, November 26, 2002; 59(10): 1541 - 1546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Bushnell and L. B. Goldstein Physician Knowledge and Practices in the Evaluation of Coagulopathies in Stroke Patients Stroke, April 1, 2002; 33(4): 948 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Bushnell, Z. Siddiqi, and L. B. Goldstein Improving patient selection for coagulopathy testing in the setting of acute ischemic stroke Neurology, October 9, 2001; 57(7): 1333 - 1335. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
