(1293) Impact of a Pharmacist-Driven Service on the Management of Heparin-Induced Thrombocytopenia

Introduction: Heparin Induced Thrombocytopenia (HIT) is a life-threatening immune complication occurring in up to 5% of patients treated with a heparin product. Current evidence based guidelines recommend definitive criteria to test patients for HIT and provide clear guidance for anticoagulation management. Despite guideline recommendations, recent literature has shown that HIT laboratory testing routinely occurs inappropriately and HIT anticoagulation management is not in line with best practices. Studies have also shown that a multi-disciplinary approach to HIT management improves compliance with guidelines and provides financial benefit. We implemented a pharmacy consult service to make recommendations on testing and treatment of patients with suspected HIT to improve our institutions overall management of this patient population.

Methods: This was a pre-post observational study. Patients with a HIT antibody test order were evaluated for inclusion. The pre-intervention period data was collected via retrospective chart review. Following implementation of the pharmacy consult service, data for the post-intervention period was collected prospectively. The primary endpoint was the percentage of appropriate HIT antibody tests ordered based on a 4Ts score calculation. Additional endpoints included the percentage of patients with a heparin agent discontinued, non-heparin agent initiation, positive HIT diagnosis, and the incidence of bleeding.

Results: Ninety patients were included in the pre-intervention period, and forty-six in the post-intervention period. For the primary endpoint, 42% of patients in the pre-intervention period had an appropriate HIT antibody test ordered compared to 67% in the post-intervention period ((95% CI, 0.15 to 0.78, P = 0.0066). Positive trends were seen in the additional endpoints of heparin agent discontinuation, non-heparin agent initiation, and the number of positive HIT tests in the post-intervention period. Bleeding events were similar between both groups.

Conclusions: Implementation of a pharmacy HIT consult service was successful in improving patient outcomes related to the assessment and management of patients with suspected HIT.