Date:
Patient:
MRN:
Clincian: (Hematologist, Internist)
Reason for Visit:
Evaluation for suspected HIT
Review of laboratory results (platelet count)
Assessment of response to alternative anticoagulation
Discussion of management plan
History of Present Illness:
Briefly describe the timeline of events:
Date of initiation of heparin therapy (unfractionated heparin or LMWH)
Onset of thrombocytopenia (timing in relation to heparin exposure)
Presence or absence of new thrombosis (blood clot)
Current symptoms (bleeding, pain, swelling in a limb)
Past Medical History:
Underlying medical condition requiring anticoagulation (deep vein thrombosis, pulmonary embolism)
History of previous heparin exposure and any prior reactions
Other relevant medical history (autoimmune diseases)
Risk Factors:
Identify any potential risk factors for HIT:
Previous heparin exposure
History of surgery, trauma, or immobilization
Infectious processes
Social History:
Not typically relevant unless affecting medication adherence.
Physical Exam:
Vital Signs: May be normal unless complications arise (bleeding, signs of thrombosis).
Focused exam on the area of suspected thrombosis (e.g., leg exam for DVT).
Labs:
Platelet count:
Decreasing platelet count after heparin exposure is suggestive of HIT.
HIT antibody testing:
Confirmation of HIT relies on specific laboratory tests (e.g., serotonin release assay, heparin-induced platelet aggregation assay). Results may take some time.
Consider mentioning other labs ordered as needed (coagulation studies, D-dimer).
Imaging:
Imaging studies may be performed to diagnose a new thrombosis (e.g., Doppler ultrasound for DVT, CT scan for PE).
Assessment:
Summarize the clinical suspicion for HIT based on the time course of heparin exposure, platelet count drop, and presence or absence of a new thrombosis.
Mention if HIT antibody testing is pending.
Plan:
Outline the treatment plan:
Immediate cessation of heparin: The most crucial step in managing HIT.
Alternative anticoagulation:
Warfarin (vitamin K antagonist) can be used for long-term anticoagulation but requires monitoring.
Fondaparinux or argatroban are direct thrombin inhibitors that can be used in HIT patients.
Consider mentioning the need for ongoing monitoring of platelet count and anticoagulation if warfarin is initiated.
Prognosis:
Briefly discuss the prognosis. With prompt diagnosis and cessation of heparin, most patients with HIT recover well.
Emphasize the importance of completing the course of alternative anticoagulation to prevent complications from the underlying thrombosis.
Education:
Document any education provided to the patient regarding:
The nature of HIT and its potential complications
The importance of avoiding heparin and heparin-containing medications
The need for ongoing monitoring and adherence to the new anticoagulation plan
Warning signs and symptoms of bleeding or worsening thrombosis
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about medication side effects, activity limitations, or the need for close follow-up.
Consider the potential emotional impact of a diagnosis like HIT and offer support or referral for mental health services if needed.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a hematologist or internist for diagnosis, treatment recommendations, and prognosis.