Abstract T P201: Utility of Ordering Activated Partial Thromboplastin Time for Acute Stroke Patients in the Emergency Department
Background: Practitioners often order coagulation studies as part of an acute stroke workup. Indiscriminate use of activated partial thromboplastin times (aPTT) is not currently supported in evidence. Pending aPTT results can delay treatment and add unnecessary cost for acute stroke patients. We sought to determine the frequency of ordering aPTT in the initial evaluation of acute stroke patients, and the utilization of results in treatment decisions.
Methods: A retrospective review of 488 records was completed on patients presenting to two primary stroke certified hospitals between August 1, 2013 and July 31, 2014. Inclusion criteria: physician activation of a code stroke in the emergency department (ED). Exclusion criteria: stroke codes initiated after hospital admission. Charts were reviewed for evidence of an aPTT order, abnormal aPTT results, and documentation of a change in medical therapy related to the aPTT results.
Results: After applying criteria, 409 records were included. Of these, 388 (94.9%) subjects had aPTT drawn for initial evaluation of suspected stroke. Prolonged aPTT was found in 21 of 388 (5.4%) subjects. Three of the 21 subjects with abnormal aPTT results came directly from dialysis and had received heparin therapy during dialysis. Two subjects were taking dabigatran. Nine subjects on warfarin with elevated aPTTs also had elevated PT/INRs, as did two subjects with hepatic encephalopathy. Five subjects had a slight increase in aPTT due to unknown etiology. None of the subjects had a change in medical treatment as a result of an elevated aPTT. Rather, elevated INR was cited as a criterion for withholding intravenous thrombolytics.
Conclusions: Although aPTTs are routinely ordered in the ED for acute stroke workup, results yield little information that impact treatment decisions. Unselected use of aPTT for initial acute stroke work up can lead to increased time to treatment while results are pending and unnecessary costs. Eliminating routine use of aPTT in acute stroke evaluation will result in significant cost savings without altering treatment.
Author Disclosures: J.M. Rockwell: None. L. Olson-Mack: None. K. Afshar: None.
- © 2015 by American Heart Association, Inc.