Reducing the hospital burden of heparin-induced thrombocytopenia: impact of an avoid-heparin program

Abstract

Key Points• Use of LMWH is associated with a lower risk of HIT and HITT compared with use of UFH.• The Avoid-Heparin Initiative resulted in a dramatic reduction in the burden of suspected HIT, adjudicated HIT, HITT, and associated costs.Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction occurring in up to 5% of patients exposed to unfractionated heparin (UFH). We examined the impact of a hospital-wide strategy for avoiding heparin on the incidence of HIT, HIT with thrombosis (HITT), and HIT-related costs. The Avoid-Heparin Initiative, implemented at a tertiary care hospital in Toronto, Ontario, Canada, since 2006, involved replacing UFH with lowmolecular-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, and HITT, along with HIT-related expenditures were compared in the pre-intervention (2003)(2004)(2005) and the avoid-heparin (2007)(2008)(2009)(2010)(2011)(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 avoidheparin phase (P < .001). The annual rate of patients with a positive HIT assay decreased 63% from 16.5 to 6.1 per 10 000 admissions (P < .001), adjudicated HIT decreased 79% from 10.7 to 2.2 per 10 000 admissions (P < .001), and HITT decreased 91% from 4.6 to 0.4 per 10 000 admissions (P < .001). Hospital HIT-related expenditures decreased by $266 938 per year in the avoid-heparin phase. To the best of our knowledge, this is the first study demonstrating the success and feasibility of a hospital-wide HIT prevention strategy. (Blood. 2016;127(16):1954-1959

Synthetic oligosaccharides can replace animal-sourced low–molecular weight heparins

“…Compared to UFH, LMWHs are more subcutaneously bioavailable, have a longer half-life, and show a decreased risk of heparin-induced thrombocytopenia (HIT), a life-threatening adverse effect associated with heparin (3, 4). LMWHs can lower the risk of HIT by as much as 63%, substantially reducing HIT-related hospital expenditures (5). However, LMWHs cannot simply be substituted for standard unfractionated heparin in cases of HIT due to their cross-reactivity with HIT antibodies (3).…”

End of the road for heparin thromboprophylaxis

“…1 Because it is well-established that LMWH is less likely to cause this highly prothrombotic adverse drug reaction than UFH, 2 it seems intuitive, at first, that using less UFH would reduce the incidence of HIT. However, implementing this policy at a system-wide level is far from simple.…”

Heparin-induced thrombocytopenia: research and clinical updates

“…In a recent study, investigators at Sunnybrook Health Sciences Center implemented an "Avoid Heparin" initiative in 2006. 15 This initiative consisted of systematic replacement of UFH with LMWH for thromboprophylaxis and/or treatment, saline catheter flushes rather than UFH, and removal of UFH from the nursing units. Comparison of outcomes of HIT testing, diagnosis, and costs before (2003)(2004)(2005) and after full implementation of this program (2007-2012) revealed a dramatic reduction in the cases of suspected HIT (85.5 vs 49.0 cases per 10 000 admissions; P , .001), positive HIT enzyme-linked immunosorbent assay (ELISA) (16.5 vs 6.1 cases per 10 000 admissions; P , .001), and adjudicated cases of HIT with and without thrombosis (10.7/4.6 vs 2.2/0.4 cases per 10 000 admissions; P , .001).…”

“…Comparison of outcomes of HIT testing, diagnosis, and costs before (2003)(2004)(2005) and after full implementation of this program (2007-2012) revealed a dramatic reduction in the cases of suspected HIT (85.5 vs 49.0 cases per 10 000 admissions; P , .001), positive HIT enzyme-linked immunosorbent assay (ELISA) (16.5 vs 6.1 cases per 10 000 admissions; P , .001), and adjudicated cases of HIT with and without thrombosis (10.7/4.6 vs 2.2/0.4 cases per 10 000 admissions; P , .001). 15 These reductions were accompanied by significant costs savings associated with caring for HIT patients from $322 321 to $55 383. 15 This study and related studies of computerized support tools employing 4Ts HIT scoring 16 suggest that disease burden can be considerably lowered through use of LMWH.…”

“…15 These reductions were accompanied by significant costs savings associated with caring for HIT patients from $322 321 to $55 383. 15 This study and related studies of computerized support tools employing 4Ts HIT scoring 16 suggest that disease burden can be considerably lowered through use of LMWH.…”