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Decision support table for suspected HIT

Decision support table for suspected HIT
ELISA OD 4 Ts score
Low (0 to 3 points)*

Pretest probability <1%

Intermediate (4 to 5 points)

Pretest probability approximately 10%

High (6 to 8 points)

Pretest probability approximately 50%

<0.60 HIT ruled out HIT ruled out HIT ruled out
0.60 to 1.49 HIT ruled outΔ HIT uncertain, order functional assay HIT uncertain, order functional assay
1.50 to 1.99 HIT uncertain, order functional assay HIT uncertain, order functional assay HIT very likely, continue treatment without further testing
≥2.00 HIT uncertain, order functional assay HIT very likely, continue treatment without further testing HIT very likely, continue treatment without further testing
This table is one of several decision support aids available for determining the need for additional testing and/or treatment for HIT. These ELISA OD values refer to the commercial assay analyzed in the study and cannot necessarily be extrapolated to other ELISA platforms. Refer to UpToDate for additional details.
HIT: heparin-induced thrombocytopenia; ELISA: enzyme-linked immunosorbent assay; OD: optical density.
* UpToDate authors would not order an ELISA in most patients with a low probability 4 Ts score. Refer to UpToDate for exceptions and rationale.
¶ The cutoff varies depending on the testing kit and laboratory; this cutoff refers to the assay used in this study.
Δ The interpretation of OD values in individuals with a low pretest probability is challenging, especially with OD values of 1.0 or higher. Clinical judgment is required to determine the best approach. Variables to consider include the certainty in the 4 Ts value, the number of points in the low probability score, changes in patient status over time, and test characteristics of the immunoassay used. Next actions depend on the availability and turnaround time of immunoassays and functional assays and the risk to the patient of initiating or withholding anticoagulation while awaiting additional test results. As an example, for an individual with an OD of 1.2 who did not have access to a rapid turnaround functional assay, UpToDate authors might repeat the ELISA the next day and base next steps on the OD value and trend.
◊ If the diagnosis of HIT is uncertain, UpToDate authors would continue treating most patients presumptively for HIT until a definitive diagnosis is made. Refer to UpToDate for exceptions and rationale.
Adapted from: Raschke RA, Curry SC, Warkentin TE, Gerkin RD. Enzyme-linked immunosorbent assay for the diagnosis of heparin-induced thrombocytopenia through the use of receiver operating characteristic analysis, stratum-specific likelihood ratios, and Bayes theorem. Chest 2013; 144:1269.
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