A Tertiary Care University Hospital Thrombosis Consultation Service: Patient Volume and Characteristics, Requesting Service and Reason for Consult

Subspecialist Thrombosis Consultation Services for the emergency department and hospital inpatients are not commonly offered, even in tertiary level care centers in Canada. Since 2006, the Jewish General Hospital, a McGill University teaching hospital in Montreal, Canada, has offered a subspecialist Thrombosis Consultation Service overseen by experienced Thrombosis Physicians. Additionally, a one year clinical Thrombosis Fellowship is offered to train physicians in Thrombosis medicine. In order to assist centers planning to start a subspecialist Thrombosis Consultation Service and to aid in the planning of future Thrombosis Fellowship curricula we performed a retrospective descriptive study of the Thrombosis Consultation Service at the Jewish General Hospital.

We reviewed all consultation requests to the Thrombosis Consultation Service at the Jewish General Hospital from July 2010 to June 2011. Copies of the completed written consultation sheets were reviewed in order to extract data on patient characteristics, reason for request, requesting service, and drugs and interventions suggested by the Thrombosis consultant. Results are presented descriptively.

The total number of written consultation sheets reviewed was 504, corresponding to an average of 42 consults seen per month. Approximately 20 additional consultation sheets could not be retrieved. Most consultations were requested by Surgical services (27.8%, n= 140), the Emergency Department (27.4%, n=138) and Internal Medicine wards (25.0%, n=123). The remaining requests were from Oncology services (6%, n=30), the Intensive Care Unit (4.4%, n=22), Family Medicine (4%, n=20), Obstetrics (2.4%, n=12) and other clinical services (2.2%, n=11). In 1.4% (n=7) the requesting service was not recorded.

The baseline characteristics of the patients are shown in Table 1.

Forty nine percent (n=248) of the consultations were for assessment of a patient with acute thrombosis as the primary reason for the consultation. The distribution of the site of thrombosis included 33.% (n=83) with pulmonary embolus with or without deep vein thrombosis (DVT), 24.6% (n=61) with lower limb proximal DVT, 14.5% (n=36) with distal DVT, 8.5% (n=21) with unusual site DVT, 8.1% (n=20) with arterial thrombosis, 5.7% (n=14) with upper extremity DVT, 4.8% (n=12) with superficial vein thrombosis and 0.4% (n=1) with extracorporeal thrombosis of a dialyzer machine.

Consultations to help manage bleeding associated with oral anticoagulant therapy (OAT) accounted for 6% (n=31) of consult requests. Other reasons for consultation included dosing of OAT (6.75%, n=34), anticoagulant bridging therapy (9.7%, n=49) and thromboprophylaxis (4.4%, n=22). Six percent (n=29) of the consultation requests were to exclude Heparin Induced Thrombocytopenia (HIT), of which a total of 4 cases were documented as confirmed HIT (0.8%).

The Thrombosis Consultation Service at the Jewish General Hospital received more than 500 consultation requests in a one year period between 2010 and 2011. These consultations were requested from a diverse array of clinical disciplines, involved adult patients of varying ages and pertained to both venous and arterial thrombotic disorders. The cases reviewed provided rich teaching material for fellows and resident trainees rounding on the service. Given the large volume of consultations requested, the emerging array of available anticoagulant drugs and the increasing complexity of cases reviewed (e.g. cancer patients, older patients with multiple comorbidities, bridging issues), there appears to be a growing need for specialized thrombosis services and formalized training of thrombosis medicine specialists.

No relevant conflicts of interest to declare.