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How do we utilize the 4Ts score?

Joseph Attallah, Abdelkader Chaar, Aryan Shiari, Dahlia Sano, Susanna Szpunar, Zyad Kafri.

Abstract
Introduction: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction in patients who have been exposed to any heparin product. It is a devastating pro-thrombotic condition; the mortality rate can be as high as 20%. The 4Ts is a clinical scoring system designed to determine the pre-test probability of HIT. A score ≤ 3 is indicative of a low probability for HIT, and no further testing is indicated per the American Society of Hematology (ASH) recommendations.
Objective: To determine how well physicians at St. John Hospital and Medical Center follow the ASH guidelines for screening for HIT based on the 4Ts.
Methods: We conducted a retrospective chart review of adult patients admitted at St John Hospital & Medical Center who had PF4/heparin (HIT) antibodies ordered between 1/1/2016 and 5/31/2017. The 4Ts at the time of testing was calculated for each patient. Data were also collected on patient management, which included discontinuation of heparin and whether alternative anticoagulation was initiated. Data were analyzed using descriptive statistics, the chi-squared test and analysis of variance followed by multiple pairwise comparisons with the Bonferroni correction of the p-value.
Results: We reviewed data from 237 patients with a mean age of 64.2 14.5 years, 54.4% were male. Analysis of the 4Ts data showed that 60.8% (144/237) of patients had scores ≤ 3 at the time of HIT antibody testing. Among the 93 patients who had 4Ts >3, heparin was stopped and another anticoagulant was started in only 23.7% of patients (22/93).
Conclusions: We concluded that HIT antibodies are often ordered in patients with low 4Ts. This increases medical expenses, hospital length of stay and the probability of over-diagnosing HIT with subsequent risks of bleeding if alternative anticoagulants are used and thrombosis if heparin is held unnecessarily. Physician education and changes to the electronic medical record may help to improve the appropriate ordering of HIT antibodies and subsequent patient management.

Key words: Heparin induced thrombocytopenia, heparin, 4T score, thrombosis, bleeding.


 
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How to Cite this Article
Pubmed Style

Attallah J, Chaar A, Shiari A, Sano D, Szpunar S, Kafri Z, . How do we utilize the 4Ts score?. IJMSR. 2018; 1(2): 5-10.


Web Style

Attallah J, Chaar A, Shiari A, Sano D, Szpunar S, Kafri Z, . How do we utilize the 4Ts score?. http://www.ijmsronline.com/?mno=13229 [Access: December 13, 2018].


AMA (American Medical Association) Style

Attallah J, Chaar A, Shiari A, Sano D, Szpunar S, Kafri Z, . How do we utilize the 4Ts score?. IJMSR. 2018; 1(2): 5-10.



Vancouver/ICMJE Style

Attallah J, Chaar A, Shiari A, Sano D, Szpunar S, Kafri Z, . How do we utilize the 4Ts score?. IJMSR. (2018), [cited December 13, 2018]; 1(2): 5-10.



Harvard Style

Attallah, J., Chaar, . A., Shiari, . A., Sano, . D., Szpunar, . S., Kafri, . Z. & (2018) How do we utilize the 4Ts score?. IJMSR, 1 (2), 5-10.



Turabian Style

Attallah, Joseph, Abdelkader Chaar, Aryan Shiari, Dahlia Sano, Susanna Szpunar, Zyad Kafri, and . 2018. How do we utilize the 4Ts score?. International Journal of Medical and Surgical Research, 1 (2), 5-10.



Chicago Style

Attallah, Joseph, Abdelkader Chaar, Aryan Shiari, Dahlia Sano, Susanna Szpunar, Zyad Kafri, and . "How do we utilize the 4Ts score?." International Journal of Medical and Surgical Research 1 (2018), 5-10.



MLA (The Modern Language Association) Style

Attallah, Joseph, Abdelkader Chaar, Aryan Shiari, Dahlia Sano, Susanna Szpunar, Zyad Kafri, and . "How do we utilize the 4Ts score?." International Journal of Medical and Surgical Research 1.2 (2018), 5-10. Print.



APA (American Psychological Association) Style

Attallah, J., Chaar, . A., Shiari, . A., Sano, . D., Szpunar, . S., Kafri, . Z. & (2018) How do we utilize the 4Ts score?. International Journal of Medical and Surgical Research, 1 (2), 5-10.