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The following is a summary of “Coagulation studies are frequently ordered in emergency department chest pain patients and do not change emergency department management,” published in the November 2024 issue of Emergency Medicine by Weinstock et al. 

Despite evidence that coagulation panels don’t impact chest pain management, they are continued to be ordered in emergency departments (ED).   

Researchers conducted a retrospective study to determine the frequency of coagulation studies (PT/INR) ordered in patients with chest pain in ED and to assess the impact of abnormal results on patient management.  

They reviewed patients with chest pain from 3 rural EDs over 49 months. Blinded medical students abstracted the data using the Gilbert and Lowenstein criteria to assess the indication for coagulation testing (PT/INR) based on liver disease or warfarin use. Subsequently, they determined if abnormal results led to therapeutic interventions or management changes in the ED.  

The results showed that from 1,200 patients with chest pain pre-COVID-19, 830 were analyzed. The coagulation panels (PT/INR) were ordered in 53.0% (440/830) of patients but were indicated in only 12.5% (55/440). Among the 385 patients without indications, 98.2% (378/385) had normal INR levels, and 1.8% (7/385) had elevated INR with no management changes in the ED for 7 patients.  

They concluded that 53% of individuals with chest pain in the ED had coagulation studies ordered, with only 12.5% being indicated and none altering management. 

Source: jem-journal.com/article/S0736-4679(24)00355-X/abstract