Table 4.

Interventions to promote safer heparin-induced thrombocytopenia management.

Intervention type	Author	Year	Country	Intervention details	Preintervention group or time frame	Postintervention group or time frame	Findings
DTI protocol implementation							•
	Kennedy et al. [37]	2011	USA	Implementation of protocol for the use of argatroban or lepirudin in the management of HIT.	19 patients	10 patients	•More subtherapeutic aPTTs after protocol implementation (14.2% vs 22%, P = .03). •Reduction in time to therapeutic aPTT (15 h vs 8.1 h, P = .677).
	Kiser et al. [36]	2011	USA	Implementation of a dosing and titration protocol for argatroban and bivalirudin use.	83 patients	47 patients	•Shorter median time to goal aPTT (13 h vs 5 h, P < .0001). •Shorter median time to dose stabilization (22 h vs 10 h, P < .0001). •Higher median percentage of aPTT values at goal (53% vs 67%, P = .027).
	Gilmore et al. [35]	2015	USA	Implementation of guidelines for bivalirudin and argatroban use, with dosing and titration guidance for 3 aPTT goal ranges, based on age, organ function, and clinical condition.	50 patients	50 patients	•Higher rate of therapeutic aPTT achievement (72% vs 92%, P < .01). •Higher rates of therapeutic aPTT with initial dose (16% vs 44%, P < .02). •Fewer number of DTI titrations to therapeutic aPTT (3.14 ± 3.02 vs 1.85 ± 2.78, P < .05).
Pharmacist-driven DTI management
	Lobo et al. [39]	2010	USA	Pharmacist oversight of all argatroban and lepirudin management based on pre-established protocols.	18 patients	17 patients	•Less common dosing errors (38% vs 9%, P = .0376). •Less heparin re-exposure after HIT diagnosis (39% vs 6%, P = .041).
	To et al. [40]	2011	USA	PDAS automatically consulted when argatroban or lepirudin ordered; PDAS selects appropriate DTI, orders initial dosing, and performs relevant lab monitoring and dosing adjustments.	95 patients	98 patients	•32% increase in time spent in therapeutic aPTT range (64.4% vs 84.7%, P < .001). •Reduction in time to therapeutic aPTT (18.9 h vs 6.4 h, P < .001). •Less bleeding events (8 vs 3, P = .130).
	Cooper et al. [38]	2012	USA	Institutional protocol where pharmacists monitor and adjust dosing of argatroban and bivalirudin infusions.	25 patients	25 patient	•Faster attainment of therapeutic aPTT (7.7 h vs 3.4 h, P = .009). •Similar rates of bleeding (12% vs 20%, P = .702) and mortality (20% vs 24%, P = .496). •Less frequent medication errors documented (40% vs. 12%, P = .05).
Reduce heparin administration during testing/promote heparin allergy documentation
	Northam et al. [41]	2021	USA	Multidisciplinary workflow involving an EMR order set triggering pharmacist and nursing consultations.	14 mo	12 mo	•Reduction in heparin product administration while HIT testing results were pending (54.2% vs 20.0%, P < .001). •Increase appropriate heparin allergy documentation (95% vs 100%, P < .001).

aPTT, activated partial thromboplastin time; DTI, direct thrombin inhibitor; EMR, electronic medical record; HIT, heparin-induced thrombocytopenia; PDAS, pharmacist-directed anticoagulation service.