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Blood coagulation disorders (coagulopathies) are a rare but recognized cause of stroke. There currently are no guidelines for when to order specialized coagulation tests to prevent further strokes in stroke patients. However, a new study suggests that neurologists could improve their use of these tests.
Educating neurologists to optimize diagnostic testing for coagulopathies in stroke patients will most likely require reminder systems, educational outreach, and other strategies, says Cheryl D. Bushnell, M.D., M.H.S., and Larry B. Goldstein, M.D., of Duke University Medical Center. Their work was supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00079).
The researchers surveyed 79 academic and community-based neurologists about their use of specialized coagulation tests and the rationale for using them in their practice and in the case of three hypothetical patients. The 59 completed surveys showed that neurologists were more likely to use these tests for young patients (76 percent), those with a history of thrombosis (46 percent) or miscarriages (36 percent), and those with few traditional stroke risk factors (35 percent)—that is, patients who are more likely to have strokes due to coagulation disorders. Only 14 percent would order tests for a hypothetical patient with traditional stroke risk factors.
Nevertheless, 46 percent of those surveyed could not identify the coagulopathy most prevalent in patients with ischemic stroke. Also, there were important discrepancies between knowledge and observed practice. For example, despite neurologists' apparent awareness of the low prevalence of hereditary coagulopathies (identified by protein C or S deficiencies) in the survey, protein C and protein S were two of the most commonly ordered specialized coagulopathy tests.
More details are in "Physician knowledge and practices in the evaluation of coagulopathies in stroke patients," by Drs. Bushnell and Goldstein, in the April 2002 Stroke 33, pp. 948-953.
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