Table 1.

Interventions to increase heparin-induced thrombocytopenia recognition.

Intervention type	Author	Year	Country	Intervention details	Preintervention group	Postintervention group	Findings
Platelet fall alert
	Andreescu et al. [18]	2000	USA	Pharmacy-based surveillance of platelet count in patients on heparin, with HIT testing ordered on patients with platelet decline.	Historical controls over 10 y	8672 patients over 3 y	•Increase in HIT testing (5 tests/y vs 26 tests/y) •Reduction in thrombosis rates in cases of confirmed HIT (50% vs 29%, P = .39)
	Riggio et al. [17]	2009	USA	EMR alert when a patient with an active order for heparin experienced a 50% platelet count decrease (or 30% if absolute platelet count was <150,000/μL) over a 3-wk time period	32,152 patients	33,452 patients	•Increase in SRA testing (610 orders vs 826 orders, P < .0001) •No impact on time from fall in platelet count to HIT testing (2.3 d vs 3.0 d, P = .30) •No impact on time to therapy (19.3 d vs 15.0 d, P = .45)
	Austrian et al. [16]	2011	USA	EMR alert when platelet count decreased by 50% or to < 100,000/μL after recent heparin exposure	1006 patients	1081 patients	•Increase in HIT ELISA orders (17.1% vs 24.6%, P = < .01) •More DTI orders in the postintervention group (2.6% vs 4.4%, P = .03) •No difference in rates of HIT antibody positivity between groups (2.8% vs 2.7%, P = .99) •No difference in LOS (49.7 vs 50.3 d, P = .94) or 90-d mortality (29.0 vs 34.2 d, P = .98)

DTI, direct thrombin inhibitor; ELISA, enzyme-linked immunosorbent assay; EMR, electronic medical record; HIT, heparin-induced thrombocytopenia; LOS, length of stay; SRA, serotonin release assay.