title: Simple scoring system for early management of heparin-induced thrombocytopenia.
abstract: This study was performed to develop a simple scoring system to aid in the early clinical management of patients suspected of heparin-induced thrombocytopenia (HIT) with regard to decisions for continued heparin therapy. The system was designed to arrive at low (0) or possible (1) probability scores without knowledge of laboratory test results (except platelet counts) to avoid delays. As the safest clinical approach is to discontinue heparin, intermediate and high scores were combined. Critically ill VA hospital patients (n = 100) with a ≥30% fall in platelet count were assessed by platelet aggregation (PA), (14)C-serotonin release assay ((14)C-SRA), and GTI ELISA. In this population, 53% were scored 1 and of these 43% were positive by laboratory test. Emphasizing the decision to discontinue heparin, the clinical signs of HIT were paramount for the immediate determination of a diagnosis of HIT without dependence on a positive laboratory test.
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL, USA.
authors.forename: Harry L
authors.initials: HL
authors.lastname: Messmore
authors.forename: Nancy
authors.initials: N
authors.lastname: Fabbrini
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bird
authors.forename: Abdul M
authors.initials: AM
authors.lastname: Choudhury
authors.forename: Miguel
authors.initials: M
authors.lastname: Cerejo
authors.forename: Margaret
authors.initials: M
authors.lastname: Prechel
authors.forename: Walter P
authors.initials: WP
authors.lastname: Jeske
authors.forename: Arshea
authors.initials: A
authors.lastname: Siddiqui
authors.forename: Indermohan
authors.initials: I
authors.lastname: Thethi
authors.forename: William H
authors.initials: WH
authors.lastname: Wehrmacher
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Walenga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010974:Platelet Aggregation; D010976:Platelet Count; D012701:Serotonin / Q000097:blood; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D012701:Serotonin; D006493:Heparin