Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

Riggio, Jeffrey; Cooper, Mandelin; Leiby, Benjamin E.; Walenga, Jeanine M.; Merli, Geno J.; Gottlieb, Jonathan E.

doi:10.1007/s11239-008-0279-x

Cited by 25 publications

(25 citation statements)

References 41 publications

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“…Criticisms of the decision analysis included the use of bleeding estimates based on doses of argatroban that are no longer used, delay in obtaining prompt results even at centers that have the SRA or HIPA available, and the potential for harm in missing cases of HIT for HIT antibodies in patients who became thrombocytopenic (5%-19%), and a low rate of initiation of a nonheparin anticoagulant when the suspicion of HIT was high enough to warrant laboratory testing (0%-55%). [73][74][75] The fi ndings of the above studies suggest previous recommendations for platelet monitoring have not been widely implemented. 76 Furthermore, when platelet count monitoring is done and platelets drop, heparin is not necessarily stopped nor is a nonheparin anticoagulant started.…”

Section: Commercially Available Elisa Using Manufacturer's Optical Dementioning

confidence: 99%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Section: Commercially Available Elisa Using Manufacturer's Optical Dementioning

confidence: 99%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Dans

Moores

et al. 2012

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855

335

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“…4 However, adherence to platelet count monitoring, testing for HIT antibodies if thrombocytopenia develops, and switching to HIT-safe anticoagulation when HIT is suspected is challenging, resource intensive, and may not reduce the adverse consequences of HIT. 6,9,[28][29][30] Previous studies have demonstrated that more than half the thrombotic events in HIT occur after the cessation of heparin without additional treatment of HIT. 8,11 In our study, we observed that more than half the HITT cases (17 of 31) had the thromboembolic event diagnosed after the diagnosis of HIT and while they were receiving HIT-safe anticoagulation, which emphasizes not only the need for early recognition and treatment but also the need to prevent HIT.…”

Section: Discussionmentioning

confidence: 99%

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

McGowan

Makari

Diamantouros

et al. 2016

Blood

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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

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“…24,25 The type and delivery of the CDSS may influence the results. Effective decision support combines information with specific mandated tasks.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

et al. 2009

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Many of the quality measures for patients with heart failure (HF) or acute myocardial infarction (AMI) require the completion of comprehensive discharge instructions, including instructions about medications to be taken after discharge. To improve compliance in a tertiary care teaching hospital with these evidence-based quality measures, a clinical-decision-support system (CDSS) that uses an electronic checklist was developed. The CDSS prompts clinicians at every training level to consistently create comprehensive discharge instructions addressing quality measures. The authors compared compliance during the 15-month preintervention and postintervention periods. Compliance with discharge measures for AMI (i.e., aspirin, beta-blocker, angiotensin-converting enzyme inhibitor [ACEI], or angiotensin receptor blocker [ARB] use) and for HF (i.e., discharge instructions, left ventricular systolic function [LVSF] evaluation, and ACEI/ARB use) was assessed. The delivery of discharge instructions showed significant improvement from the preintervention period to the postintervention period (37.2% to 93.0%; P < .001). Compliance with prescription of ACEI or ARB also improved significantly for HF (80.7% to 96.4%; P < .001) and AMI (88.1% to 100%; P = .014) patients. Compliance with the remaining measures was higher before intervention, and, thus, the modest improvement in the postintervention period was not statistically significant (AMI patients: aspirin, 97.5% to 98.8%; P = .43; and beta-blocker, 97.9% to 98.7%; P = .78; HF patients: LVSF, 99.3% to 99.1%; P = .78). Implementation of a CDSS with computerized electronic prompts improved compliance with selected cardiac-care quality measures. The design of quality-improvement decision-support tools should incorporate educational missions in their message and design.

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Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

Abstract: BACKGROUND: Subtle decreases in platelet count may impede timely recognition of heparin-

Cited by 25 publications

References 41 publications

Treatment and Prevention of Heparin-Induced Thrombocytopenia

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

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