Impact of education and electronic decision support tool on the practice of heparin-induced thrombocytopenia testing: An experience of a teaching community hospital

Department

Internal Medicine

Document Type

Article

Publication Title

Thrombosis Research

Abstract

Heparin Induced Thrombocytopenia (HIT) is a potentially life-threatening disorder caused by antibodies directed against complex of heparin and platelets factor-4 (PF-4) [ 1 ]. HIT occurs in 1 in 5000 hospitalized patients and 1–3% of patients after cardiac surgery, with the incidence being highest with the use of unfractionated heparin [ 2 ]. Hospitalized patients can develop thrombocytopenia due to a variety of causes and determining HIT as the cause of thrombocytopenia is crucial because of potential of thrombotic complications which affects 50% of the patients [ 2 ]. American Society of Hematology (ASH) recommends utilization of 4Ts score based on clinical and simple laboratory data to identify patients with high likelihood of HIT and to prevent unnecessary additional testing [ 3 ]. Low probability of HIT as determined by 4Ts score of 3 or less carries a negative predictive value of 99.8% and additional testing can safely be deferred, as HIT is unlikely and heparin can be continued safely [ 4 ]. HIT is diagnosed at our institution by testing anti-PF4/heparin antibodies by Enzyme-linked Immunosorbent Assay (ELISA; Instrumentation Laboratory, ACL TOP 500, Bedford, Massachusetts) for suspected cases. Positive results are confirmed by Serotonin Release Assay (SRA) which is sent out to Mayo Clinic, Rochester, Minnesota. Anti-PF4/heparin antibodies ELISA is an expensive test and replacement of heparin with non-heparin parenteral anticoagulants adds greatly to the heath expenditure. A study found an extra cost of $39,616 per patient suspected of having HIT in US with most of it coming from prolonged hospital stay and use of non-heparin anticoagulants [ 5 ].

In an earlier retrospective study, we found that we were overusing ELISA HIT testing for thrombocytopenia patients at Unity Hospital [ 6 ]. Therefore, we held educational sessions regarding the usefulness of 4Ts scoring and incorporated a 4 T score calculator into our Electronic Health Record (EHR) to encourage providers to order ELISA testing only when it is deemed appropriate by the Electronic Decision Support Tool (EDST). The objective of this study to evaluate the effect of education and EDST on the appropriateness of HIT testing.

First Page

73

Last Page

75

DOI

10.1016/j.thromres.2018.07.017

Volume

169

Publication Date

9-1-2018

Publisher

Pergamon Press

Medical Subject Headings

Anticoagulants; Decision Support Systems, Clinical; Enzyme-Linked Immunosorbent Assay; Heparin; Hospitals, Teaching; Humans; Retrospective Studies; Thrombocytopenia

PubMed ID

30025269

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