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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
| Implementation and Outcomes of a Pharmacist-Driven Protocol for Direct Thrombin Inhibitor Titration in Patients with Heparin-Induced Thrombocytopenia Amber L Woolley, Anne E Rose. UW Health, Madison, WI, USA |
Abstract
Background: Direct thrombin inhibitors (DTIs), argatroban and bivalirudin, are alternative parenteral anticoagulants used in patients with suspected or confirmed heparin-induced thrombocytopenia (HIT). Because they are utilized far less frequently than heparin products, clinicians have limited experience with titration and management. Pharmacists are frequently delegated authority for management of other anticoagulants such as heparin and warfarin, with successful outcomes.. DTIs represent an additional opportunity for pharmacist management to improve the medication use process. Purpose: To describe the development of a pharmacist-driven delegation protocol for titration of DTIs in patients with HIT, and to assess the safety and efficacy after implementation. Methods: A pharmacist-driven delegation protocol for management of DTI in HIT was created. A retrospective chart review of active DTI orders pre and post protocol implementation will be completed. Data collected will include baseline PTT, 4T score and optical density score, frequency of PTT testing, time to target anticoagulation goal, and reported bleeding events.. Primary outcomes include adherence to the institutional DTI titration guideline recommendations for PTT monitoring frequency and time from initiation of infusion to attainment of the goal PTT. Primary safety outcomes will include bleeding events during DTI therapy and other medication safety events reported through the institution’s safety event reporting tool. Results: Prior to implementation of the protocol, 53 orders for argatroban or bivalirudin for suspected or confirmed HIT were identified between December 2023 and April 2025. PTT monitoring was performed in adherence with the institutional guideline in 30 of these patients (56.6%). 46 patients (83%) achieved the target PTT before the DTI was discontinued. Among these patients, the mean time from initiation of the infusion to attainment of the goal PTT was 16 hours. Post-implementation data collection and analysis is pending. Conclusions: We anticipate that the transition to a pharmacist-led titration protocol will decrease the time to achieve goal PTT, improve adherence to the institution’s internal DTI titration guideline, and decrease the frequency of DTI-related bleeding events and other events reported to the institution’s safety event reporting tool.
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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.