Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia

Abstract

Use of direct-thrombin inhibitors (DTIs) for the management of patients with heparin-induced thrombocytopenia (HIT) is challenging. A pharmacist-managed DTI protocol was implemented to standardize and improve the care of patients with HIT. A background study that compared DTI protocol–treated patients to those who did not receive treatment with the DTI protocol found that significantly more of the DTI protocol–treated patients received care that was consistent with level 1 guidelines from the American College of Chest Physicians (41% vs 0%). Because outcomes were poor regardless of whether the DTI protocol was used, the protocol was revised to require pharmacist implementation and oversight. A follow-up study compared DTI protocol patients from the background study (non-pharmacist-managed) to the pharmacist-managed DTI protocol group. There were significantly fewer dosing errors, improved nursing documentation, and less reexposure to heparin when the pharmacist was responsible for managing the DTI protocol. A trend toward reduced bleeding was noted. The management of patients with HIT is complex, and there are a number of pitfalls that may lead to poor outcomes. DTIs are high-risk medications that require careful dosing and monitoring to minimize risk for adverse drug events. A DTI protocol may improve care of patients with HIT, and pharmacist oversight of DTI use can help to reduce risk for errors and adverse medication events.