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The Incidence of Recognized Heparin-Induced Thrombocytopenia in a Large Tertiary Care, Teaching Hospital

¹Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak MI and Professor, Department of Pharmacy Practice, Wayne State University, Detroit, MI ²Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak MI and Adjunct Assistant Professor, Department of Pharmacy Practice, Wayne State University, Detroit, MI jkoerber@beaumont.edu ³Division of Hematopathology, Department of Clinical Pathology, William Beaumont Hospital, Royal Oak MI jmattson@beaumont.edu

msmythe{at}beaumont.edu

Abstract

BackgroundHeparin-induced thrombocytopenia HIT is estimated to occur in up to 5% of patients receiving unfractionated heparin. The goal was to determine the incidence of HIT within our 1061-bed tertiary-care institution.

MethodsA retrospective review of three hospital database systems admission, pharmacy and laboratory was undertaken for a one year period ending March 2004. The pharmacy database was queried to identify patients who received heparin and those who received a direct thrombin inhibitor DTI. Medical records of patients receiving a DTI were reviewed to categorize the indication for DTI therapy. The laboratory system database was queried to retrieve heparin platelet factor 4 HPF4 immunoassay results.

Results58,814 patient admissions occurred with an estimated 24,068 patients being exposed to unfractionated heparin. DTI therapy was administered in 133 patients. Of these, 49 new HIT cases and 15 cases of suspected HIT unconfirmed were identified. The overall incidence of recognized new HIT was 0.2%. New HIT occurred in 0.76% of patients receiving therapeutic-dose intravenous heparin and < 0.1% in patients receiving antithrombotic prophylaxis subcutaneous heparin. Forty-nine percent of all new HIT cases were in coronary artery bypass and/or valve replacement surgery patients while no cases were identified in hip/knee arthroplasty patients.

ConclusionsThe incidence of recognized HIT in a large teaching institution was 0.2% with a 0.76% incidence in those patients receiving therapeutic-dose intravenous heparin. The low incidence likely reflects a brief duration of heparin exposure for many patients. Approximately half of all new HIT cases were recognized in the cardiovascular surgery population.

Key Words: heparin-induced thrombocytopenia

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Who Is (Still) Getting HIT?

Theodore E. Warkentin and John W. Eikelboom
Chest 2007 131: 1620-1622. [Full Text] [PDF]

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				T. E. Warkentin and A. Greinacher So, Does Low-Molecular-Weight Heparin Cause Less Heparin-Induced Thrombocytopenia Than Unfractionated Heparin or Not? Chest, October 1, 2007; 132(4): 1108 - 1110. [Full Text] [PDF]