Clinical decision support to reduce unnecessary diagnostic testing for heparin-induced thrombocytopenia

Br J Haematol. 2023 Sep;202(5):1011-1017. doi: 10.1111/bjh.18902. Epub 2023 Jun 4.

Abstract

Appropriate evaluation of heparin-induced thrombocytopenia (HIT) is imperative because of the potentially life-threatening complications. However, overtesting and overdiagnosis of HIT are common. Our goal was to evaluate the impact of clinical decision support (CDS) based on the HIT computerized-risk (HIT-CR) score, designed to reduce unnecessary diagnostic testing. This retrospective observational study evaluated CDS that presented a platelet count versus time graph and 4Ts score calculator to clinicians who initiated a HIT immunoassay order in patients with predicted low risk (HIT-CR score 0-2). The primary outcome was the proportion of immunoassay orders initiated but cancelled after firing of the CDS advisory. Chart reviews were conducted to assess anticoagulation usage, 4Ts scores and the proportion of patients who had HIT. In a 20-week period, 319 CDS advisories were presented to users who initiated potentially unnecessary HIT diagnostic testing. The diagnostic test order was discontinued in 80 (25%) patients. Heparin products were continued in 139 (44%) patients, and alternative anticoagulation was not given to 264 (83%). The negative predictive value of the advisory was 98.8% (95% CI: 97.2-99.5). HIT-CR score-based CDS can reduce unnecessary diagnostic testing for HIT in patients with a low pretest probability of HIT.

Keywords: decision support systems, clinical; drug-related side effects and adverse reactions; heparin; quality improvement; thrombocytopenia.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticoagulants / adverse effects
  • Decision Support Systems, Clinical*
  • Heparin / adverse effects
  • Humans
  • Platelet Count
  • Predictive Value of Tests
  • Thrombocytopenia* / chemically induced
  • Thrombocytopenia* / diagnosis

Substances

  • Heparin
  • Anticoagulants