(1259) Evaluation of Heparin-Induced Thrombocytopenia Management at a Large Community Hospital

Introduction: Heparin Induced Thrombocytopenia (HIT) is a life-threatening immune complication occurring in up to 5% of patients treated with a heparin product. Current evidence based guidelines recommend definitive criteria to test patients for HIT and provide clear guidance for anticoagulation management. Despite guideline recommendations, recent literature has shown that HIT laboratory testing routinely occurs inappropriately and HIT anticoagulation management is not in line with best practices. Studies have also shown that a multi-disciplinary approach to HIT management improves compliance with guidelines and provides financial benefit. We evaluated HIT testing and treatment at our institution with the goal of identifying areas to optimize patient care and safety, apply evidence-based treatment protocols, and decrease excess cost.

Methods: We conducted a multi-center, retrospective chart review of patients who had a heparin antibody test ordered over one year. Outcomes included the percentage of patients with an appropriate test order based on a calculated 4Ts score of greater than 3, whether or not an appropriate non-heparin anticoagulant was initiated, whether or not the heparin agent was discontinued, and the incidence of bleeding and thrombosis.

Results: Of the 141 patients evaluated, 90 were identified for inclusion. The majority (58%) of tests were ordered in patients who did not meet criteria for testing. 42% of patients with an appropriate test were initiated on a non-heparin anticoagulant, and 20% did not have the heparin agent discontinued despite suspicion of HIT. 14% of patients had no known history of heparin administration. A positive test resulted in 7 (8%) of patients. Major bleeding events occurred in 3 patients, all treated with argatroban. A confirmed thrombus was present in 20 patients.

Conclusions: Similar to recently published literature, the majority of patients evaluated for suspected HIT were not managed in alignment with current guidelines. These findings justify the implementation of a multi-disciplinary service for HIT management at our institution.