Interfacing Pharmacy and Laboratory Systems to Reduce the Use of Heparin Products During Heparin Induced Thrombocytopenia Work-Up
Project Description: Heparin products, including heparin, low-molecular weight heparins, and other pharmaceutical products, are frequently used in the hospital setting for their anticoagulant effects. Most commonly, heparin and low-molecular weight heparins are used as prophylaxis against venous thromboembolic (VTE) events. It has been shown that hospitalized patients are at an increased risk for the development of a VTE events. In 2005, The Joint Commission began monitoring VTE prophylaxis rates within the hospital setting and it is now consider a core measure. The current Joint Commission Core Measure requires all patients age 18 or older to receive VTE prophylaxis or have an exclusion from VTE prophylaxis documented in the medical record. These products are frequently used for VTE treatment as well. Furthermore, a number of products, such as line flushes, contain heparin. One serious complication associated with the use of these products is Heparin Induced Thrombocytopenia (HIT). HIT is a disorder characterized by thrombocytopenia and high risk for thrombosis. It is caused by an antibody that targets a complex of heparin and platelet factor 4 (PF4) on the platelet surface. The incidence of HIT varies by population and risk stratification—the incidence in some cohorts is as high as 5%. A history of HIT is considered a contraindication to the use of heparin, low molecular heparins, and heparin containing products. At UF Health Shands, we utilize 2 methods for the diagnosis of HIT: 1. Heparin Platelet Antibody, which detects circulating antibodies. 2. Serotonin Release Assay, which measures C-serotonin release from activated platelets. The typical diagnostic approach for HIT is to order a heparin platelet antibody. If the test is positive then a serotonin release assay is ordered. During HIT work-up, the receipt of heparin, low-molecular weight heparins, and heparin containing products, should be avoided. Ordering providers may not always be aware of a pending HIT work-up when ordering heparin products for patients. Therefore, a change was made within EPIC, the UF Health Shands electronic medical record, to alert providers when heparin products are ordered for a patient with an ordered or processing heparin platelet antibody lab and/or serotonin release assay.
QPI: Matthew, Wright, (email@example.com)
Collaborators: Benjamin, Staley, (firstname.lastname@example.org)
UF Health Big Aims: Zero Harm None
MeSH Keywords: Allergy and Immunology, Anticoagulants, Heparin, Heparin, Low-Molecular-Weight, Thrombocytopenia