From Julia Witt: Our healthcare system is currently looking at more efficient ways to screen for heparin-induced thrombocytopenia with thrombosis (HIT). Currently we are looking at the Akers Biosciences PIFA AB test. The literature looks good, but I wonder how many are using this test and can it be reliably used as a rule out test for HIT? Our current workflow is to place our patients on direct thrombin inhibitors (DTIs) until we have a confirmation by the serotonin release assay (SRA). This is time-consuming and costly. So a faster TAT with an ability to reliably rule out is very necessary. What are others doing and if using PIFA AB testing, what are their thoughts and yours as well?
Hi, Julia, I have no first-hand experience with the PIFA kit since 2006, however I know Akers Biosciences made some upgrades to the method in 2009 to enhance the readability, which previously could be equivocal. The idea of a rapid test is attractive for the reasons you suggest. I’ve had a couple of posts on the subject this past year, they are entitledRapid HIT Assays, and Validating a Rapid HIT Assay. Neither has generated a response. The companies with assays in Europe have not tried to “crack” the currently impenetrable FDA with their kits, so Akers currently has no competition in the US.
Excellent point. The 4Ts Pre-Test scoring system is rarely u
Excellent point. The 4Ts Pre-Test scoring system is rarely used. Our HCO currently has a clinical pathway for CV and DVT testing. I pointed out to the pathway committee a possible opportunity for improving the number of patients tested was to implement the 4T system and have not had a response.
I am surprised thaat there has been no discuss
I am surprised thaat there has been no discussion so far of the 4Ts Pre-test Clinical score (Warkentin BJH 2003, 121,535. which we use together with Diamed PaGIA Heparin/PF4 followed by confirmation (much later) with SRA for both positive and negative PaGIA. Considering the poor specificity of all immunologic methods, the clinical assessment is the most important in my opinion.