Heparin-Induced Thrombocytopenia (HIT)

This vignette details the new clinical decision support (CDS) that was developed to facilitate a provider’s workup and diagnosis of heparin-induced thrombocytopenia (HIT). When ordering a PF4 lab, the completion of the 4T score assessment is now mandatory. Additionally, alerts have been developed for providers, pharmacists and nursing to ensure that all are aware of any pending or resulted PF4 labs.

Target Audience

Cardiovascular Disease Prevention Physicians, Cardiologists, Critical Care Medicine Physicians, eICU Physicians, Emergency Department Physicians, Family Medicine Physicians, Geriatric Medicine Physicians, Hematologists, Oncologists, Hospitalists, Internal Medicine Physicians, Interventional and Clinical Pulmonologists, Interventional Cardiologists, Neurocritical Care Physicians, Palliative Care Physicians, Preventive Medicine Physicians and Pulmonologists.

Learning Objectives

  • Utilize the electronic medical record to adhere to evidence-based clinical care pathways. 
  • Explain the 4T score and clinical indications for ordering a PF4 lab. 
  • Recognize the importance of the multidisciplinary approach when testing patients suspected of heparin induced thrombocytopenia.
Additional information
Bibliography: 
  • (2016). Infusion therapy standards of practice. Norwood, MA: Infusion Nurses Society; Wolters Kluwer 
  • AABB, October 2107, Circular of Information: For the Use of Human Blood and Blood Components brochure, 74 pages, ISBN 978-1-56395-956-1 
  • Cuker, A., Arepally, G.M., Chong, B.H., Cines, D.B.,. . .Santesso, N (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia Blood Advances 2018 2:3360-3392; doi: https://doi.org/10.1182/bloodadvances.2018024489 
  • Davidson, J. C., Rahim, S., Hanks, S. E., Patel, I. J., Tam, A. L., Walker, T. G., . . . Sarode, R. (2019). Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations. Journal of Vascular and Interventional Radiology. https://doi:10.1016/j.jvir.2019.04.016 
  • Emergency Medicine: Coagulation Studies in Patients Presenting with Chest Pain with No Coagulopathy or Bleeding. (n.d.). Retrieved from https://www.acepnow.com/article/emergency-medicine: coagulation-studies-in-patients-presenting-with-chest-pain-with-no-coagulopathy-or-bleeding/ 
  • George, J.N. & Arnold, D.M. (2018). Approach to the adult with unexplained thrombocytopenia. In Wolters Kluwer (Ed.). UptoDate. Retrieved June 11th, 2019, from https://www.uptodate.com/contents/ approach-to-the-adult-with-unexplained-thrombocytopenia 
  • Heparin-Induced Thrombocytopenia (HIT). The Ohio State University Wexner Medical Center, Columbus, Ohio. November 30th, 2016, Edition 4. The Ohio State University. 
  • Kaufman, R. M., Djulbegovic, B., Gernsheimer, T., Kleinman, S., Tinmouth, A. T., Capocelli, K. E., . . . Tobian, A. A. (2015). Platelet Transfusion: A Clinical Practice Guideline From the AABB. Annals of Internal Medicine, 162(3), 205. https://doi:10.7326/m14-1589 
  • Lee, T., Huang, J., Lee, K., Lai, C., Chen, S., & Kuo, C. (2014). The use of platelet transfusion in thrombocytopenic patients for phacoemulsification. Taiwan Journal of Ophthalmology, 4(1), 52-55. https://doi:10.1016/j.tjo.2013.06.003 
  • Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4: 759–65 
  • Nagler, M., Bachmann, L. M., Cate, H. T., & Cate-Hoek, A. T. (2015). Diagnostic value of immunoassays for heparin-induced thrombocytopenia: A systematic review and meta-analysis. Blood, 127(5), 546-557. https://doi:10.1182/blood-2015-07-661215 
  • Patel, I. J., Rahim, S., Davidson, J. C., Hanks, S. E., Tam, A. L., Walker, T. G., . . . Weinberg, I. (2019). Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations. Journal of Vascular and Interventional Radiology. https://doi:10.1016/j.jvir.2019.04.017 
  • Warkentin, T. E., & Anderson, J. A. (2016). How I treat patients with a history of heparin-induced thrombocytopenia. Blood, 128(3), 348–359. https://doi.org/10.1182/blood-2016-01-635003
Course summary
Available credit: 
  • 0.25 AMA PRA Category 1 Credit™
  • 0.25 General certificate of attendance
Course opens: 
08/01/2020
Course expires: 
07/31/2023

Vignettes developed and designed by the Evidence-Based Clinical Care Team.

Content Contributors

  • Meagan Rodriguez
  • Henry Triana Jr.

Content contributors indicated that neither they nor their spouses/partners have relevant financial relationships with commercial interest companies, and they will not include off-label or unapproved product usage in their presentation(s) or discussion(s).

Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose.

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Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Baptist Health has been re-surveyed by the ACCME and awarded Commendation for 6 years as a provider of CME for physicians.
              
Baptist Health South Florida designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Available Credit

  • 0.25 AMA PRA Category 1 Credit™
  • 0.25 General certificate of attendance
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