Impact of electronic medical record‐based calculation of 4Ts on heparin‐induced thrombocytopenia (HIT) testing: A single center experience

2021 ◽  
Author(s):  
Mofiyin Obadina ◽  
Hannah L. McRae ◽  
Rialnat Lawal ◽  
Majed A. Refaai ◽  
Frank Akwaa
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Single Center ◽  
Heparin Induced Thrombocytopenia ◽  
Single Center Experience

Dosing lepirudin in patients with heparin-induced thrombocytopenia and normal or impaired renal function: a single-center experience with 68 patients

Blood ◽  
2009 ◽  
Vol 113 (11) ◽  
pp. 2402-2409 ◽  
Author(s):  
Martina Tschudi ◽  
Bernhard Lämmle ◽  
Lorenzo Alberio
Keyword(s):  
Impaired Renal Function ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Single Center ◽  
Dosing Regimen ◽  
Heparin Induced Thrombocytopenia ◽  
Single Center Experience ◽  
Therapeutic Anticoagulation ◽  
D Dimer ◽  
Anticoagulation Intensity

The recommended dose (bolus 0.4 mg/kg followed by 0.15 mg/kg per hour) of lepirudin, a direct thrombin inhibitor licensed for treatment of heparin-induced thrombocytopenia (HIT), is too high. Starting in 2001, we omitted the bolus and reduced maintenance dose by at least one-third. Analyzing 53 HIT patients treated between January 2001 and February 2007, we observed that therapeutic anticoagulation intensity already 4 hours after lepirudin start had been reached with the following initial lepirudin doses (median): 0.078 mg/kg per hour [creatinine clearance (CrCl) more than 60 mL/min], 0.040 mg/kg per hour (CrCl 30-60 mL/min), and 0.013 mg/kg per hour (CrCl < 30 mL/min). The efficacy of this treatment was documented by increasing platelets and decreasing D-dimers. Based on this experience, we derived a lepirudin dosing regimen, which was prospectively evaluated treating 15 HIT patients between March 2007 and February 2008. We show that omitting the initial lepirudin bolus and administering 0.08 mg/kg per hour in patients with CrCl more than 60 mL/min, 0.04 mg/kg per hour in patients with CrCl 30-60 mL/min, and 0.01 to 0.02 mg/kg per hour in those with CrCl less than 30 mL/min is efficacious and safe, as documented by increasing platelet counts, decreasing D-dimer levels, and rare thrombotic (1 of 46) and major bleeding (4 of 46) complications.

Differences in Biologic Utilization and Surgery Rates in Pediatric and Adult Crohn’s Disease: Results From a Large Electronic Medical Record-derived Cohort

2020 ◽  
Author(s):  
Jacob A Kurowski ◽  
Alex Milinovich ◽  
Xinge Ji ◽  
Janine Bauman ◽  
David Sugano ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Multivariable Analysis ◽  
Adult Onset ◽  
Single Center ◽  
Pediatric Onset ◽  
Over Time

Abstract Background and Aims Crohn’s disease (CD) is a chronic illness that affects both the pediatric and adult populations with an increasing worldwide prevalence. We aim to identify a large, single-center cohort of patients with CD using natural language processing (NLP) in combination with codified data and extract surgical rates and medication usage from the electronic medical record (EMR). Methods Patients with CD were identified from the entire Cleveland Clinic EMR using ICD codes and CD-specific terms identified by NLP to fit a logistic regression model. Cohorts were developed for pediatric-onset (younger than 18 years) and adult-onset (18 years and older) CD. Surgeries were identified using current procedural terminology (CPT) codes and NLP. Crohn’s disease–related medications were extracted using physician orders in the EMR. Results Patients with pediatric-onset (n = 2060) and adult-onset (n = 4973) CD were identified from 2000 to 2017 with a positive predictive value of 98.5%. Rate of CD-related abdominal surgery over time was significantly higher in adult-onset compared with pediatric-onset CD (10-year surgery rate 49.9% vs 37.7%, respectively; P &lt; 0.001). Treatment with biologics was significantly higher in pediatric vs adult-onset CD cohorts (63.6% vs 49.2%; P &lt; 0.001). The overall rate of CD-related abdominal surgery was significantly higher in those who received &lt;6 months of a biologic compared with ≥6 months of a biologic for both cohorts (pediatric 64.1% vs 39.1%, P ≤ 0.001; adult 69.3% vs 56.5%, P ≤ 0.001). Additionally, 60.9% in pediatric-onset CD and 43.5% in adult-onset CD treated with ≥6 months of biologic therapy have not required abdominal surgery. On multivariable analysis, perianal surgery was a significant risk factor for abdominal surgery in both cohorts. Conclusion We used a combination of codified and NLP data to establish the largest, North American, single-center EMR cohort of pediatric- and adult-onset CD patients and determined that biologics are associated with lower rates of surgery over time, potentially altering the natural history of the disease.

Heparin-induced thrombocytopenia treated with fondaparinux: single center experience

2020 ◽  
Vol 39 (1) ◽  
Author(s):  
Petr Dulicek ◽  
Eva Ivanova ◽  
Milan Kostal ◽  
Zuzana Fiedlerova ◽  
Petr Sadilek ◽  
...  
Keyword(s):  
Single Center ◽  
Heparin Induced Thrombocytopenia ◽  
Single Center Experience

scholarly journals Rapid exclusion or confirmation of heparin-induced thrombocytopenia: a single-center experience with 1,291 patients

Haematologica ◽  
2011 ◽  
Vol 97 (1) ◽  
pp. 89-97 ◽  
Author(s):  
V. Nellen ◽  
I. Sulzer ◽  
G. Barizzi ◽  
B. Lammle ◽  
L. Alberio
Keyword(s):  
Single Center ◽  
Heparin Induced Thrombocytopenia ◽  
Single Center Experience
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