Complete the Self-Assessment Performance Review

Use this checklist to evaluate your current practices with patients who are at risk for heparin-induced thrombocytopenia (HIT). This can be used to review specific patient charts or as a guide to think about which components are currently implemented in your standard protocols for patients at risk for or undergoing treatment of HIT.

All fields required

Presentation
Platelet count at presentation (x 10⁹/L)	150 100-150 50-100 20-50 < 20
Platelets with respect to baseline	80% 50-80% 30-50% < 30%
Is there a known cause of thrombocytopenia?	Recent surgery or procedure Glycoprotein IIB-IIIA inhibitors Antibiotics Sepsis ITP MDS Chemotherapy None known
Current anticoagulants	UFH LMWH Fondaparinux Argatroban Lepirudin Bivalirudin Warfarin
If heparin was given recently, how long ago was it stopped?	> 100 days 15-100 days 5-14 days 1-4 days Not stopped, current
Evidence of blood disorder	Bleeding Thrombosis Anemia Other
Other signs of thrombosis?	Skin Lesions? Yes No Acute systemic reactions following bolus? Fever Chills Tachycardia Dyspnea Transient global amnesia
Heparin exposure?	Current UFH LMWH Prior UFH LMWH
"4T" Evaluator
Thrombocytopenia	> 50% fall, nadir ≥ 20 x 10⁹/L 30-50% fall or nadir 10-19 x 10⁹/L < 30% fall or nadir < 10 x 10⁹/L
Timing of platelet count fall consistent with HIT	Clear onset days 5-10 or ≤ day 1 (recent heparin) Possible No (< day 4)
Thrombosis	Yes Possible No
Other causes of thrombocytopenia?	No Possible Likely
Confirmatory Tests
PF-4/heparin antibody test?	Positive Negative
Serotonin release assay?	Positive Negative
If HIT was diagnosis,
Which management steps did you take?	Stopped all heparins Initiated alternative anticoagulant (not warfarin) Transitioned to warfarin
What was the outcome?	Uneventful resolution of thrombocytopenia Thrombosis PE Acute systemic reaction Acute limb ischemia Necrosis Amputation Stroke MI Death
Did this analysis influence your subsequent patient management?	Yes No
Did this analysis influence your workplace practices?	Yes No