HIT-It or Quit It: Heparin-Induced Thrombocytopenia Testing Appropriateness Using 4T Scoring and Inappropriate Testing Cost Analysis

South Med J. 2021 Jul;114(7):401-403. doi: 10.14423/SMJ.0000000000001266.

Abstract

Objectives: The American Society of Hematology's 4T scoring system is a validated tool to assess a patient's probability of having heparin-induced thrombocytopenia (HIT) before testing is performed. There is no benefit to testing patients with a low probability 4T score for HIT. This study aimed to assess for inappropriate HIT testing at our institution based on 4T scoring.

Methods: We retrospectively reviewed 201 patient charts and calculated 4T scores and testing costs to assess for inappropriate testing and the economic impact of such testing.

Results: HIT testing often occurred in the least appropriate patients and resulted in tens of thousands of dollars of waste for unnecessary testing.

Conclusions: Inappropriate testing for HIT is still a prevalent issue despite literature supporting the 4T score for guidance in testing appropriateness.

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Clinical Laboratory Techniques / economics
  • Clinical Laboratory Techniques / standards
  • Clinical Laboratory Techniques / statistics & numerical data
  • Cost-Benefit Analysis / classification*
  • Cost-Benefit Analysis / methods
  • Female
  • Heparin / adverse effects*
  • Heparin / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Overtreatment / economics*
  • Overtreatment / prevention & control
  • ROC Curve
  • Retrospective Studies
  • Thrombocytopenia / etiology*

Substances

  • Anticoagulants
  • Heparin