[Multidisciplinary consultation for the prescription of danaparoid in suspected heparin-induced thrombocytopenia].
BACKGROUND
Heparin-induced thrombocytopenia (HIT) is a serious immune complication of heparin therapy and presents a risk of severe thromboembolic events. Withdrawal of heparin together with administration of an alternative antithrombotic agent is always necessary in patients with suspected HIT. Diagnosis of this complication, however, is often difficult, particularly in hospitalized patients. The aim of this study was to evaluate the impact of multidisciplinary consultation on the appropriate prescription of danaparoid, widely used as an alternative antithrombotic treatment in HIT.


METHODS
Multidisciplinary consultation between clinician, hematologist, and pharmacist called for reassessment of the HIT diagnosis at day 3 and between day 3 and 10 after the beginning of danaparoid treatment. Continuation or stopping treatment depended on their joint conclusion. All danaparoid prescriptions were evaluated according to this procedure for one year.


RESULTS
HIT was suspected in 26 in-patients. The multidisciplinary approach made it possible to reassess the HIT diagnosis on day 3 and stop the alternative treatment in 42.3% of cases. Danaparoid use decreased by 52% compared with the previous year.


CONCLUSIONS
Multidisciplinary consultations between clinician, hematologist, and pharmacist appear useful for minimizing inappropriate prescription of this alternative treatment in cases of suspected HIT.
Verdy
Elisabeth
E
Service d'hématologie biologique, Paris, Cedex. elisabeth.verdy@tnn.aphp.fr
Debrix
Isabelle
I
Benomar
Amina
A
Becker
Annie
A
Flahault
Antoine
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010348:Patient Care Team; D010976:Platelet Count; D011336:Probability; D012017:Referral and Consultation; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D005343:Fibrinolytic Agents; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid