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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Appropriateness of Heparin-Induced Thrombocytopenia Testing and Associated Patient Outcomes Across Intermountain Health Aminah R.Altalhi, Clinton S.Anderson, Scott C.Woller, Dave S.Collingridge, Gabriel V.Fontaine. Intermountain Health, Salt Lake, UT, USA |
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated complication of heparin exposure, occurring in ≤1% of patients exposed to heparin. Notably, up to 64% of patients with confirmed HIT experience thrombosis including arterial and venous clots that can lead to limb loss. However, the rarity of HIT requires that pretest probability of the condition be considered before laboratory testing occurs. Because HIT is a feared complication, mindful physicians wish to refute this diagnosis with negative laboratory testing. For this reason, unnecessary testing for HIT is frequent. Diagnostic stewardship of HIT testing is formidable. 50–75% of HIT testing is unnecessary, wasteful, and associated with potential harm. Guidelines recommend using a pre-test probability tool such as the ‘4Ts Score’ to guide appropriate testing. Over-testing may result in the premature discontinuation of heparin, avoidable initiation of costly non-heparin anticoagulants, increased laboratory monitoring, elevated bleeding risk, and unnecessary resource utilization. We will report the appropriateness of HIT testing across Intermountain Health hospitals, and the potential impact diagnostic stewardship could have on the health system. Objectives: Report the rate of appropriate HIT testing in our integrated 32 hospital not-for-profit healthcare system and report variable anticoagulant utilization, diagnostic yield, bleeding, length of stay, and costs. Methods: This retrospective cohort study will include adults admitted to an Intermountain Health hospital who had a PF4 immunoassay or/and a serotonin release assay (SRA) obtained between January 1, 2019 and December 31, 2024. Eligible patients were identified through MDClone, with manual chart review to document thrombosis history, platelet counts, and an assessment of HIT testing appropriateness. Patient demographics, exposure to heparin and heparin dose (prophylactic v. therapeutic; unfractionated v. low molecular weight) post-hoc calculation of a ‘4T’ score on the date of the test being ordered (or documentation of a ‘4T’ score if present), anticoagulant administration, clinically overt bleeding and thrombosis events will be recorded. Descriptive statistics and comparative analyses between groups will be used to evaluate differences between patients that received testing that was deemed appropriate vs inappropriate. Results: Data extraction and manual review are in progress. Available results will be presented at the time of the poster presentation. Conclusions: This study will report HIT testing practices among patients that received care at an Intermountain Health hospital. The appropriateness of HIT testing and patient and societal-important outcomes will be reported.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.