PMID- 26817956
OWN - NLM
STAT- MEDLINE
DCOM- 20160926
LR  - 20220408
IS  - 1528-0020 (Electronic)
IS  - 0006-4971 (Linking)
VI  - 127
IP  - 16
DP  - 2016 Apr 21
TI  - Reducing the hospital burden of heparin-induced thrombocytopenia: impact of an 
      avoid-heparin program.
PG  - 1954-9
LID - 10.1182/blood-2015-07-660001 [doi]
AB  - 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.
CI  - (c) 2016 by The American Society of Hematology.
FAU - McGowan, Kelly E
AU  - McGowan KE
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      Department of Medicine, University of Toronto, Toronto, ON, Canada;
FAU - Makari, Joy
AU  - Makari J
AD  - Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      and.
FAU - Diamantouros, Artemis
AU  - Diamantouros A
AD  - Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      and Leslie Dan Faculty of Pharmacy.
FAU - Bucci, Claudia
AU  - Bucci C
AD  - Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      and Leslie Dan Faculty of Pharmacy.
FAU - Rempel, Peter
AU  - Rempel P
AD  - Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      and.
FAU - Selby, Rita
AU  - Selby R
AD  - Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 
      Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of 
      Clinical Pathology, and.
FAU - Geerts, William
AU  - Geerts W
AD  - 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.
LA  - eng
PT  - Journal Article
DEP - 20160127
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Blood. 2016 Apr 21;127(16):1945-6. PMID: 27103740
CIN - Ann Transl Med. 2016 Jun;4(12):244. PMID: 27428830
MH  - Economics, Hospital/*organization & administration
MH  - Female
MH  - *Health Care Costs/statistics & numerical data/trends
MH  - Heparin/*adverse effects
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Hospitalization/statistics & numerical data
MH  - Hospitals/statistics & numerical data
MH  - Humans
MH  - Iatrogenic Disease/economics/epidemiology
MH  - Incidence
MH  - Male
MH  - Primary Prevention/methods/organization & administration
MH  - *Safety Management/methods/organization & administration
MH  - Thrombocytopenia/*chemically induced/*economics/epidemiology/*prevention & 
      control
EDAT- 2016/01/29 06:00
MHDA- 2016/09/27 06:00
CRDT- 2016/01/29 06:00
PHST- 2015/07/31 00:00 [received]
PHST- 2016/01/13 00:00 [accepted]
PHST- 2016/01/29 06:00 [entrez]
PHST- 2016/01/29 06:00 [pubmed]
PHST- 2016/09/27 06:00 [medline]
AID - S0006-4971(20)30234-2 [pii]
AID - 10.1182/blood-2015-07-660001 [doi]
PST - ppublish
SO  - Blood. 2016 Apr 21;127(16):1954-9. doi: 10.1182/blood-2015-07-660001. Epub 2016 
      Jan 27.