A Computerized Scoring System to Improve Assessment of Heparin-induced Thrombocytopenia Risk.
J Thromb Haemost. 2018 Dec 14;:
Authors: Gallo T, Curry SC, Padilla-Jones A, Heise CW, Ramos KS, Woosley RL, Raschke RA
BACKGROUND: Heparin induced thrombocytopenia (HIT) is an immune-mediated adverse drug event associated with life-threatening thrombotic complications. The four T's (4Ts) score is widely used to estimate the risk for HIT and guide diagnostic testing, but it is not easily amenable to computerized clinical decision support (CDS) implementation.
OBJECTIVES: Our main objective was to develop a HIT computerized risk (HIT-CR) scoring system that provides platelet count surveillance for timing and degree of thrombocytopenia to identify those for whom diagnostic testing should be considered. Our secondary objective was to evaluate clinical management and subsequent outcomes in those identified to be at risk for HIT.
METHODS: We retrospectively analyzed data from a stratified sample of 150 inpatients treated with heparin to compare the performance of the HIT-CR scoring system to a clinically calculated 4Ts score. We took a 4Ts score ≥4 as the gold standard to determine if HIT diagnostic testing should be performed.
RESULTS: The best cutoff point of the HIT-CR score was a score of 3 which yielded 85% raw agreement with the 4Ts score and a kappa of 0.69 (95% CI: 0.57 to 0.81). Ninety percent of patients with 4Ts score ≥4 failed to undergo conventionally recommended diagnostic testing; 38% of these experienced persistent, unexplained thrombocytopenia, and 4% suffered life-threatening thrombotic complications suggestive of undiagnosed HIT.
CONCLUSION: The HIT-CR scoring system is practical for computerized CDS, agrees well with the 4Ts score, and should be prospectively evaluated for its ability to identify patients who should be tested for HIT. This article is protected by copyright. All rights reserved.
PMID: 30552743 [PubMed - as supplied by publisher]