Thromb Haemost 2012; 108(05): 992-998
DOI: 10.1160/TH12-05-0289
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Assessing the impact of a heparin-induced thrombocytopenia protocol on patient management, outcomes and cost

Maureen A. Smythe
1   Department of Pharmaceutical Services, Beaumont Hospital, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, USA
,
John M. Koerber
1   Department of Pharmaceutical Services, Beaumont Hospital, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, USA
,
Trupti P. Mehta
1   Department of Pharmaceutical Services, Beaumont Hospital, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, USA
,
Lisa L. Forsyth
1   Department of Pharmaceutical Services, Beaumont Hospital, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, USA
,
Elizabeth Conger
2   Department of Pharmaceutical Services, Beaumont Hospital, Royal Oak, Michigan, USA
,
Lindsey R. Corbets
2   Department of Pharmaceutical Services, Beaumont Hospital, Royal Oak, Michigan, USA
3   Currently: Department of Pharmaceutical Services, Presbyterian Healthcare Services, Rush Medical Center, Rio Rancho, New Mexico, USA
,
Joan C. Mattson
4   Department of Clinical Pathology, Beaumont Hospital, Royal Oak, MI, USA
› Author Affiliations
Further Information

Publication History

Received: 03 May 2012

Accepted after major revision: 09 August 2012

Publication Date:
29 November 2017 (online)

Preview

Summary

Establishing the diagnosis of heparin induced thrombocytopenia (HIT) is challenging as laboratory tests for HIT vary in specificity and availability. As HIT suspicion far exceeds confirmation of diagnosis, overtreatment is an emerging concern. This pilot study evaluated the impact of a HIT Recognition and Management Protocol on direct thrombin inhibitor (DTI) prescribing, outcomes, and cost. The primary endpoint was DTI cessation within 12 hours of receipt of negative HIT serology. An observational cohort study using a pre-post design was performed. Sixty-one patients were in the pre-period (before implementation) and 46 in the post-period (after implementation). DTI therapy was discontinued within 12 hours of negative serology in 19.4% of pre-period patients compared to 40% of post-period patients, p=.058. DTI therapy was discontinued within 24 hours of receipt of a negative PF4/heparin ELISA more often in the post-period ; 7/23 (30.4%) pre-period patients versus 16/26 (61.5%) post-period patients, p <0.05. Protocol implementation resulted in a significant improvement in timely initiation of DTI therapy (within 12 hours of HIT antibody testing) in those with a moderate to high suspicion of HIT; 8/31 (25.8%) of pre-period patients versus 24/31 (77.4%) of post-period patients, p <0.0001. Thrombotic events occurred in significantly more patients in the pre-period as compared to the post-period; 21/61 (34.4%) versus 6/46 (13%), respectively, p = 0.01. Major bleeding was reduced by 6.6 % after protocol implementation. The projected annual cost savings from decreased inappropriate DTI use was over $450,000. Protocol implementation had a positive impact on DTI prescribing, outcomes and cost.