Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.
Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
Int J Lab Hematol. 2021 Dec;43(6):1599-1605. doi: 10.1111/ijlh.13658. Epub 2021 Jul 18.
Management of patients with suspected heparin-induced thrombocytopenia (HIT) can lead to significant costs. Reported cost-saving initiatives have focused on minimizing inappropriate testing in low-risk patients and optimizing alternative anticoagulant selection. We sought to further investigate how utilizing various HIT laboratory testing models would impact total cost of testing and alternative anticoagulant use.
Utilizing a retrospective cohort of adult patients tested for HIT over three years within our institution, we evaluated how utilization of four distinct laboratory models impacted total number of HIT test combinations completed, time to HIT testing finalization, percentage of patients discharged from the hospital prior to HIT testing finalization, total alternative anticoagulant days, and total anticipated major bleed events. Additionally, we calculated cost of laboratory testing and alternative anticoagulant associated with each model.
A total of 482 patients were included in our cohort. A laboratory testing model that utilized an in-house platelet factor 4 (PF4)-heparin enzyme-linked immunosorbent assay (ELISA) completed three days weekly, and reflex serotonin release assay (SRA) with a five-day turnaround resulted in the shortest mean time to HIT testing finalization, lowest percentage of patients discharged prior to HIT testing finalization, and lowest total alternative anticoagulant days.
Institutions should evaluate current HIT laboratory testing practices and assess for opportunities for optimization. Testing models utilizing a PF4-heparin antibody ELISA with a reflex SRA for positive results may improve testing metrics and lead to lower utilization of alternative anticoagulants.
疑似肝素诱导血小板减少症（HIT）患者的管理可能会导致巨大的成本。已报道的节约成本举措主要集中在减少低风险患者的不当检测和优化替代抗凝剂的选择上。我们试图进一步研究使用各种 HIT 实验室检测模型如何影响检测总成本和替代抗凝剂的使用。
利用我们机构三年内接受 HIT 检测的成年患者的回顾性队列，我们评估了四种不同的实验室模型的使用如何影响完成的 HIT 检测组合的总数、HIT 检测完成的时间、在 HIT 检测完成之前出院的患者比例、替代抗凝剂的总天数以及预计的主要出血事件总数。此外，我们计算了每个模型的实验室检测和替代抗凝剂相关成本。
我们的队列共纳入 482 名患者。每周进行三次内部血小板因子 4（PF4）-肝素酶联免疫吸附试验（ELISA）和五天周转时间的反射性血清素释放试验（SRA）的实验室检测模型，导致 HIT 检测完成的平均时间最短，在 HIT 检测完成之前出院的患者比例最低，以及替代抗凝剂的总天数最低。
各机构应评估当前的 HIT 实验室检测实践，并评估优化的机会。使用 PF4-肝素抗体 ELISA 进行检测，对阳性结果进行反射性 SRA 检测的模型可能会改善检测指标，并降低替代抗凝剂的使用。
