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.

Original Release Date: August 2020
Course Review Date: August 2023

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: 
  • Gorski L. A. (2017). The 2016 Infusion Therapy Standards of Practice. Home healthcare now, 35(1), 10–18.
  • 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., Greinacher, A., Gruel, Y., Linkins, L. A., Rodner, S. B., Selleng, S., Warkentin, T. E., Wex, A., Mustafa, R. A., Morgan, R. L., & Santesso, N. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood advances, 2(22), 3360–3392.
  • Davidson, J. C., Rahim, S., Hanks, S. E., Patel, I. J., Tam, A. L., Walker, T. G., Weinberg, I., Wilkins, L. R., & 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: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. Journal of vascular and interventional radiology : JVIR, 30(8), 1155–1167.
  • 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., Cipolle, M. D., Cohn, C. S., Fung, M. K., Grossman, B. J., Mintz, P. D., O'Malley, B. A., Sesok-Pizzini, D. A., Shander, A., Stack, G. E., Webert, K. E., Weinstein, R., Welch, B. G., Whitman, G. J., Wong, E. C., … AABB (2015). Platelet transfusion: a clinical practice guideline from the AABB. Annals of internal medicine, 162(3), 205–213. https://doi.org/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.
  • Lo, G. K., Juhl, D., Warkentin, T. E., Sigouin, C. S., Eichler, P., & Greinacher, A. (2006). Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. Journal of thrombosis and haemostasis : JTH, 4(4), 759–765.
  • Nagler, M., Bachmann, L. M., Cate, H. T., & Cate-Hoek, A. J. T. (2016b). Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood, 127(5), 546–557.
  • Patel, I. J., Rahim, S., Davidson, J. C., Hanks, S. E., Tam, A. L., Walker, T. G., Wilkins, L. R., Sarode, R., & 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: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. Journal of vascular and interventional radiology : JVIR, 30(8), 1168–1184.e1.
Course Summary
Available credit: 
  • 0.25 AMA PRA Category 1 Credit™
  • 0.25 General certificate of attendance
Course opens: 
08/01/2020
Course expires: 
07/31/2025
Part of: 
Evidence-Based Clinical Care: Pathway Updates e-Learning Series

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

Content Contributors

  • Meagan Rodriguez
  • Henry Triana Jr.

Content contributors have no relevant financial relationship with ineligible companies* to disclose and have indicated that the presentation or discussion will not include off-label or unapproved product usage. 

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

*Ineligible companies -- Companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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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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