Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
J Thromb Haemost. 2017 Feb;15(2):370-374. doi: 10.1111/jth.13565. Epub 2016 Dec 24.
Essentials Misdiagnosis of heparin-induced thrombocytopenia (HIT) may be associated with adverse outcomes. We conducted a study of patients with a heparin allergy in the chart due to misdiagnosis of HIT. 42% of patients with a heparin allergy due to suspected HIT were clearly HIT-negative. 68% were unnecessarily treated with an alternative anticoagulant, 66% of whom had major bleeding.
Background It is recommended that heparin be added to the allergy list of patients with heparin-induced thrombocytopenia (HIT). Misdiagnosis of HIT could lead to inappropriate documentation of a heparin allergy and adverse outcomes. Objectives To determine the frequency and consequences of inappropriate documentation of a heparin allergy because of misdiagnosis of HIT. Methods We conducted a cohort study of patients with an inappropriate heparin allergy listed in the electronic medical record (EMR) because of misdiagnosis of HIT. We searched the EMR for patients with a new heparin allergy. Patients were eligible if the reason for allergy listing was suspected acute HIT and laboratory testing for HIT was performed within 60 days. Subjects were defined as 'HIT-negative' if they had a 4Ts score of ≤ 3 or negative laboratory test results. Results Of 239 subjects with a new heparin allergy documented because of concern regarding HIT, 100 (42%) met the prespecified definition of HIT-negative. Sixty-eight (68%) HIT-negative subjects unnecessarily received an alternative parenteral anticoagulant for a median duration of 10.5 days. Among these 68 patients, 45 (66%) met criteria for major bleeding. Sixty-eight (68%) of the 100 HIT-negative subjects had an inappropriate allergy to heparin documented that persisted in the EMR for > 3 years beyond the index hospitalization. Conclusions Inappropriate listing of heparin as an allergy in the EMR because of misdiagnosis of HIT is common, is associated with substantial rates of unnecessary alternative anticoagulant use and major bleeding, and tends to persist beyond the index admission.
肝素诱导的血小板减少症（HIT）误诊可能与不良结局有关。我们对因误诊 HIT 而在病历中记录有肝素过敏的患者进行了一项研究。42%因疑似 HIT 而记录有肝素过敏的患者实际上 HIT 阴性。68%的患者被不必要地使用了替代抗凝剂，其中 66%有大出血。
背景：建议将肝素添加到肝素诱导的血小板减少症（HIT）患者的过敏列表中。HIT 误诊可能导致肝素过敏的不当记录和不良结局。目的：确定因误诊 HIT 而不当记录肝素过敏的频率和后果。方法：我们对因误诊 HIT 而在电子病历（EMR）中记录有不当肝素过敏的患者进行了队列研究。我们在 EMR 中搜索有新肝素过敏的患者。如果过敏列表的原因是怀疑急性 HIT，并且在 60 天内进行了 HIT 实验室检测，则患者符合条件。如果 4Ts 评分≤3 或实验室检测结果为阴性，则将患者定义为“HIT 阴性”。结果：在因担心 HIT 而记录的 239 例新肝素过敏患者中，有 100 例（42%）符合预先规定的 HIT 阴性定义。68%（68%）的 HIT 阴性患者因不必要地接受了中位数为 10.5 天的替代静脉抗凝剂治疗。在这 68 例患者中，有 45 例（66%）符合大出血标准。在 100 例 HIT 阴性患者中，有 68%（68%）在 EMR 中记录了对肝素的不当过敏，这种过敏在索引住院后超过 3 年仍持续存在。结论：因误诊 HIT 而在 EMR 中不当记录肝素过敏很常见，与不必要的替代抗凝剂使用和大出血的发生率较高有关，并且往往会持续到索引住院后。
