title: Reducing the hospital burden of heparin-induced thrombocytopenia: impact of an avoid-heparin program.
abstract: 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 low-molecular-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 (2003-2005) and the avoid-heparin (2007-2012) 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 avoid-heparin phase ( ITALIC! P< .001). The annual rate of patients with a positive HIT assay decreased 63% from 16.5 to 6.1 per 10 000 admissions ( ITALIC! P< .001), adjudicated HIT decreased 79% from 10.7 to 2.2 per 10 000 admissions ( ITALIC! P< .001), and HITT decreased 91% from 4.6 to 0.4 per 10 000 admissions ( ITALIC! 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.
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada;
authors.forename: Kelly E
authors.initials: KE
authors.lastname: McGowan
authors.affiliation: Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and.
authors.forename: Joy
authors.initials: J
authors.lastname: Makari
authors.affiliation: Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Leslie Dan Faculty of Pharmacy.
authors.forename: Artemis
authors.initials: A
authors.lastname: Diamantouros
authors.affiliation: Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Leslie Dan Faculty of Pharmacy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bucci
authors.affiliation: Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and.
authors.forename: Peter
authors.initials: P
authors.lastname: Rempel
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Clinical Pathology, and.
authors.forename: Rita
authors.initials: R
authors.lastname: Selby
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Patient Safety, University of Toronto, Toronto, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Geerts
mesh_terms: D004469:Economics, Hospital / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D006493:Heparin / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics / Q000453:epidemiology; D015994:Incidence; D008297:Male; D011322:Primary Prevention / Q000379:methods / Q000458:organization & administration; D017751:Safety Management / Q000379:methods / Q000458:organization & administration; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D006495:Heparin, Low-Molecular-Weight; D006493:Heparin