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Algorithm for Heparin-Induced Thrombocytopenia
J Thromb Haemost; ePub 2017 Jul 17; Raschke, et al
An algorithm incorporating the 4Ts pretest clinical scoring system and a stratified interpretation of the anti-PF4/H ELISA has the potential to improve management of patients thought to have heparin-induced thrombocytopenia (HIT), according to a retrospective cohort study involving 181 individuals.
Participants had undergone anti-PF4/H ELISA and serotonin release assay (SRA) between 2010 and 2014. Investigators determined the algorithm recommendation for each patient, compared recommendations with the clinical care received, and tallied discrepancy consequences. Among the results:
- The algorithm accurately stratified 98% of patients, ruling out HIT in 158, ruling in HIT in 10, and recommending an SRA in 13.
- Adhering to the algorithm would have avoided 165 SRAs and prevented 30 courses of unnecessary antithrombotic therapy.
Raschke R, Gallo T, Curry S, et al. Clinical effectiveness of a Bayesian algorithm for the diagnosis and management of heparin-induced thrombocytopenia. [Published online ahead of print July 17, 2017]. J Thromb Haemost. doi:10.1111/jth.13758.