Reducing the hospital burden of heparin-induced thrombocytopenia: impact of an avoid-heparin program.
Blood. 2016 Jan 27;
Authors: McGowan KE, Makari J, Diamantouros A, Bucci C, Rempel P, Selby R, Geerts W
Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin, occurring in up to 5% of patients exposed to unfractionated heparin (UFH). We examined the impact of a hospital-wide, avoid-heparin strategy on the incidence of HIT, HIT with thrombosis and HIT-related costs. This "Avoid-Heparin Initiative", implemented at a tertiary-care hospital in Toronto, Canada since 2006, involved replacing UFH with low molecular weight heparin (LMWH) for prophylactic and therapeutic indications. Consecutive cases with suspected HIT from 2003 through 2012 were reviewed. Rates of suspected HIT, adjudicated HIT, HIT with thrombosis, and HIT-related expenditures were compared in the pre-intervention (2003-2005) and the Avoid-Heparin (2007-2012) phases. The annual rate of suspected HIT decreased 42%, from 85.5 per 10,000 admissions in the pre-intervention phase to 49.0 per 10,000 admissions in the Avoid-Heparin phase (p<0.001). The annual rate of patients with a positive HIT assay decreased 63% from 16.5 to 6.1 per 10,000 admissions (p<0.001); adjudicated HIT decreased 79% from 10.7 to 2.2 per 10,000 admissions (p<0.001); and HIT with thrombosis decreased 91% from 4.6 to 0.4 per 10,000 admissions (p<0.001). Hospital HIT-related expenditures decreased by $266,938 per year in the Avoid-Heparin phase. To our knowledge, this is the first study demonstrating the success and feasibility of a hospital-wide HIT prevention strategy.
PMID: 26817956 [PubMed - as supplied by publisher]