Assessment of a modified 4T scoring system for heparin-induced thrombocytopenia in critically ill patients

Fiorenza, Mallory; Frazee, Erin; Personett, Heather; Dierkhising, Ross A.; Schramm, Garrett E.

doi:10.1016/j.jcrc.2013.12.010

Cited by 15 publications

(21 citation statements)

References 35 publications

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“…The 4th criterion "oTher causes of thrombocytopenia" generated the most disagreement. A modified 4Ts score omitting this criterion was assessed, but did not improve pretest probability (65). An observational study suggests that specificity of laboratory tests for HIT antibodies increases without losing sensitivity when they are limited to patients presenting with a significant platelet count fall after day 4 of ICU admission (2) (▶ Figure 1).…”

Section: Intensive Care Unit Patients Frequency Diagnosis and "Prophmentioning

confidence: 99%

Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients

Selleng

Selleng²

2016

Thromb Haemost

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SummaryThrombocytopenia as well as anti-platelet factor 4/heparin (PF4/H) antibodies are common in cardiac surgery patients and those treated in the intensive care unit. In contrast, heparin-induced thrombocytopenia (HIT) is uncommon in these populations (~1 % and ~0.5 %, respectively). A stepwise approach where testing for anti-PF4/H antibodies is performed only in patients with typical clinical symptoms of HIT improves diagnostic specificity of the laboratory assays without losing sensitivity, thereby helping to avoid overdiagnosis and resulting HIT overtreatment. Short-term re-exposure to heparin, especially given intraoperatively for cardiovascular surgery, is a reasonable therapeutic option in patients with a history of HIT who subsequently test negative for HIT antibodies. Organ failure(s), enhanced bleeding risks, and other characteristics require special considerations regarding non-heparin anticoagulation: Argatroban is the alternative anticoagulant with pharmacokinetics independent of renal function, but it has a prolonged half-life in case of impaired liver function. For bivalirudin, protocols during cardiopulmonary bypass surgery are established, and it is suitable for patients with liver insufficiency. A major issue of direct thrombin inhibitors are false high activated partial thromboplastin time values in patients with comorbidities affecting prothrombin, which can result in systematic underdosing of the drugs. This is not the case for danaparoid and fondaparinux, which can be monitored by anti-factor Xa assays, but have long half-lives and no suitable antidote. This review includes also information on management of on-and off-pump cardiac surgery, ventricular assist devices, percutaneous interventions, continuous renal replacement therapy, and extracorporeal membrane oxygenation in patients with HIT.

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Section: Intensive Care Unit Patients Frequency Diagnosis and "Prophmentioning

confidence: 99%

Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients

Selleng

Selleng²

2016

Thromb Haemost

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“…

Recent studies have showed the use of clinical 4T scoring in critically ill is not reliable and may be lead to inappropriate use of direct agents and then increase of bleeding rate [4,[19][20][21]. HIT is occurred more common with unfractionated heparin (UFH) than

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confidence: 99%

Enoxaparin in Suspected Heparin Induced Thrombocytopenia: An Observational Follow-Up in Critically Ill Patients

Beigmohammadi¹

2018

BJSTR

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“…[14][15][16] Although the HIT ELISA confers high sensitivity, due to its detection of nonpathogenic antibodies, its specificity can range from 74% to 84%. 15 Therefore, in the setting of a low 4T's score, HIT testing is not only unnecessary, it can be harmful due to the risk of treating a false positive result. For instance, assuming an average HIT prevalence of 1% and a false positive rate of 16% (specificity 84%), 1/17 (5.6%) patients with a positive ELISA will have HIT if testing is pursued in an indiscriminate manner.…”

Section: Why You Should Not Test Low Probability Patients For Hitmentioning

confidence: 99%

Things We Do For No Reason: HIT Testing in Low Probability Patients

Hicks

Fan

2019

Journal of Hospital Medicine

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Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason" series reviews practices which have become common parts of hospital care but which may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

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Assessment of a modified 4T scoring system for heparin-induced thrombocytopenia in critically ill patients

Cited by 15 publications

References 35 publications

Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients

Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients

Enoxaparin in Suspected Heparin Induced Thrombocytopenia: An Observational Follow-Up in Critically Ill Patients

Things We Do For No Reason: HIT Testing in Low Probability Patients

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