Retrospective Analysis of Heparin-Induced Thrombocytopenia Management at a Large Tertiary Hospital

Frank C. Passero Jr., Marin Xavier


Background: Heparin-induced thrombocytopenia (HIT) is a disease that is difficult to quickly and accurately diagnose. The 4T score calculation is often used to determine the probability of HIT in order to guide further work-up and therapeutics. Our study aims to assess current practices regarding the diagnosis and management of HIT, particularly in reference to the appropriateness and cost of work-up and initiation of heparin alternatives based on the 4T score.

Methods: A retrospective chart review was carried out on patients at Scripps Mercy San Diego for whom work-up had been pursued with HIT antibody test and/or serotonin release assay between May 2011 and May 2012. For each of these patients a 4T score assessing the probability of HIT was carried out based on available chart information.

Results: Of the 218 work-ups reviewed, 74% had a low pre-test probability of HIT and 53% occurred in the medical intensive care unit (ICU). Only five of the 218 work-ups and one of the 116 ICU patient work-ups resulted in a diagnosis of HIT. The cost of using heparin alternatives in patients without a final diagnosis of HIT was approximately $100,750 and the cost of pursuing serologic work-up in patients with a low 4T score was $33,360. Average optical density (OD) scores among patients with a low and intermediate 4T score did not reach the threshold value for positivity with values of 0.257 and 0.334, respectively. Patients in the high 4T score group had average OD values of 1.68, which is 5 above the threshold for a positive result and the probability of HIT being present did not reach 50% until the OD was above 1.40.

Conclusions: This study demonstrates the significant costs associated with HIT diagnosis and management at a large hospital. Implementing a clinical decision support system to mitigate inappropriate ordering of serologic studies and initiation of heparin alternatives may be cost-saving. Further prospective studies will need to be undertaken to test this hypothesis.

J Hematol. 2014;3(2):27-33


Heparin-induced thrombocytopenia; Systems-based analysis; Heparin alternatives; Cost analysis

Full Text: HTML PDF
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe



Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board



Company Profile

Editorial Office

Misconduct and Retraction


Company Registration

Contact Us

Abstracting and Indexing



Instructions to Authors


Declaration of Helsinki

Contact Publisher

Submission Checklist


Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy


Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians


Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal


Journal of Hematology, quarterly, ISSN 1927-1212 (print), 1927-1220 (online), published by Elmer Press Inc.               
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:    editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.