PMID- 19690229
OWN - NLM
STAT- MEDLINE
DCOM- 20091102
LR  - 20131121
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 43
IP  - 9
DP  - 2009 Sep
TI  - Compliance with platelet count monitoring recommendations and management of 
      possible heparin-induced thrombocytopenia in hospitalized patients receiving 
      low-molecular-weight heparin.
PG  - 1405-12
LID - 10.1345/aph.1L646 [doi]
AB  - BACKGROUND: Summaries of product characteristics (SPCs) and clinical guideline 
      recommendations are available for monitoring the platelet count for 
      heparin-induced thrombocytopenia (HIT) in patients receiving low-molecular-weight 
      heparin (LMWH). Testing for the presence of heparin-platelet factor 4 antibodies 
      (HPF4-Ab) and starting alternative anticoagulation is recommended when HIT is 
      suspected. OBJECTIVE: To investigate the frequency of compliance with 
      recommendations for platelet count monitoring and management of possible HIT in 
      hospitalized patients receiving prophylaxis and treatment dosing of LMWH for at 
      least 5 consecutive days. METHODS: A retrospective cohort study within the 
      Utrecht Patient Oriented Database (UPOD) was conducted. For all inpatients, all 
      episodes of exposure to dalteparin or nadroparin for at least 5 consecutive days 
      in 2004-2005 were selected. In 4 different nonexclusive groups of patients (all 
      pts. receiving dalteparin, all pts. receiving nadroparin, surgical pts. with a 
      prophylactic dose of either dalteparin or nadroparin, and pts. exposed to 
      unfractionated heparin [UFH] within 100 days before receiving either dalteparin 
      or nadroparin), compliance with recommendations for platelet count monitoring 
      from SPCs and a clinical guideline was studied. The frequency of compliance with 
      these recommendations was determined. In addition, it was determined whether 
      patient and treatment characteristics were associated with regular platelet count 
      monitoring. Finally, the frequency of testing for HPF4-Ab and the initiation of 
      danaparoid treatment in patients with a drop of at least 50% in platelet count 
      were investigated. RESULTS: A total of 6804 patients, with 7770 episodes of LMWH 
      treatment, were included in the analysis. The frequency of compliance with 
      platelet count monitoring recommendations was 26.3% for all patients receiving 
      dalteparin, 35.6% for all patients receiving nadroparin, 23.0% for surgical 
      patients receiving prophylactic dosing of either dalteparin or nadroparin, and 
      41.5% for patients exposed to UFH within 100 days before the start of either 
      dalteparin or nadroparin treatment. Regular platelet count monitoring was 
      strongly positively associated with medical patients (relative risk [RR] 2.33), 
      surgical patients (RR 2.03), critically ill patients (RR 2.80), and those with 
      recent exposure to UFH (RR 2.19). The frequency of testing for HPF4-Ab was 5.4% 
      and the initiation of alternative anticoagulation with danaparoid in patients 
      with a 50% drop in platelet count was 0%. CONCLUSIONS: The results suggest that 
      compliance with recommendations for platelet count monitoring and management of 
      possible HIT is low at our institution. Policies and tools to improve compliance 
      with recommended laboratory monitoring should be developed to secure the safe use 
      of LMWH and other medications.
FAU - ten Berg, Maarten J
AU  - ten Berg MJ
AD  - Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for 
      Pharmaceutical Sciences, Utrecht University, Netherlands.
FAU - van den Bemt, Patricia M L A
AU  - van den Bemt PM
FAU - Huisman, Albert
AU  - Huisman A
FAU - Schobben, Alfred F A M
AU  - Schobben AF
FAU - Egberts, Toine C G
AU  - Egberts TC
FAU - van Solinge, Wouter W
AU  - van Solinge WW
LA  - eng
PT  - Journal Article
DEP - 20090818
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Nadroparin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
CIN - Ann Pharmacother. 2009 Sep;43(9):1519-21. PMID: 19690223
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*adverse effects/therapeutic use
MH  - Cohort Studies
MH  - Dalteparin/*adverse effects/therapeutic use
MH  - Databases, Factual
MH  - Drug Monitoring/methods
MH  - Female
MH  - Guideline Adherence
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nadroparin/*adverse effects/therapeutic use
MH  - Platelet Count
MH  - Practice Guidelines as Topic
MH  - Retrospective Studies
MH  - Thrombocytopenia/*chemically induced
EDAT- 2009/08/20 09:00
MHDA- 2009/11/03 06:00
CRDT- 2009/08/20 09:00
PHST- 2009/08/20 09:00 [entrez]
PHST- 2009/08/20 09:00 [pubmed]
PHST- 2009/11/03 06:00 [medline]
AID - aph.1L646 [pii]
AID - 10.1345/aph.1L646 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2009 Sep;43(9):1405-12. doi: 10.1345/aph.1L646. Epub 2009 Aug 
      18.