Heparin-induced thrombocytopenia (HIT) is an immune complication of heparin therapy
caused by antibodies to complexes of platelet factor 4 (PF4) and heparin. Patients
with HIT present with a decline in platelet count following heparin exposure and may
or may not have thrombosis or hemorrhage. About as high as one-half of the cases of
HIT are complicated by venous and/or arterial thrombosis which may be limb- or life-threatening
[
[1]
]. Morbidity in these patients is further increased by bleeding (∼x223C40%) associated
with the use of potent non-heparin anticoagulants [
[2]
]. Establishing a diagnosis of HIT requires both clinical probability and laboratory
testing. Clinical scoring systems such as the 4Ts score (due to a very high negative
predictive value when low), offer a robust means to exclude a diagnosis of HIT [
[3]
]. However, these strategies are under-employed in clinical practice and limited evidence
indicates a high prevalence of over-testing for HIT. We conducted the current study
to investigate ordering practices for diagnosing HIT in hospitalized patients.Keywords
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References
- A 14-year study of heparin-induced thrombocytopenia.Am J Med. 1996; 101: 502-507
- The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia.J Thromb Haemost. 2019; 17: 1956-1965
- Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings.J Thromb Haemost. 2006; 4: 759-765
- Over-testing for heparin induced thrombocytopenia in hospitalized patients.J Thromb Thrombolysis. 2015; 40: 12-16
- American society of hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia.Blood Adv. 2018; 2: 3360-3392
- Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome.J Intensive Care. 2013; 1: 9
- Enforcing the "4T": an in-line calculator for HIT antibody ordering in the electronic medical record.R I Med J. 2020; 103: 78-83
- Is the incidence trend of heparin-induced thrombocytopenia decreased by the increased use of low-molecular-weight-heparin?.Mediterr J Hematol Infect Dis. 2015; 7e2015029
Article info
Publication history
Published online: April 11, 2022
Accepted:
April 5,
2022
Received in revised form:
April 3,
2022
Received:
March 26,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
