{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T04:04:42Z","timestamp":1763611482948,"version":"3.45.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the appropriateness and clinical indication of ordering the heparin-induced thrombocytopenia (HIT) platelet factor 4 (PF4) tests (based on the 4T score) for the diagnosis of HIT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 261 PF4\/polyvinylsulfonate (PVS)\u2013enzyme-linked immunosorbent assay (ELISA) tests performed for 261 patients between January 2020 and June 2022. Patients were divided into 2 groups: 4T score less than 4 (unindicated HIT test requests) and 4T score of 4 or more (appropriately indicated HIT test requests). Clinical characteristics, test results, and treatment decisions were compared between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Only 136 (52.11%) of 261 tests were indicated by a 4T score or 4 or higher, whereas 125 (47.89%) of 261 tests were performed in low-probability patients (4T score\u2005&amp;lt;4). The PF4\/PVS-ELISA positivity rate did not differ significantly between groups (11.03% vs 5.6%, P\u2005=\u2005.125). Patients with indicated testing had higher baseline platelet counts, longer time to platelet drop, and a greater percent drop in platelets (all P\u2005&amp;lt;\u2005.001). Among the 22 PF4\/PVS-ELISA positive cases, only 10 had serotonin release assay (SRA) testing performed, of which 2 were SRA-positive. Among patients with low clinical probability, 75.20% (94\/125) had heparin discontinued, despite the minimal risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most HIT testing was inconsistent with guideline recommendations of the American Society of Hematology. Overtesting may lead to unnecessary anticoagulation, and undertreatment may have occurred in high-risk cases. These findings underscore the need for improved implementation of 4T-based decision tools to guide HIT evaluation and treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajcp\/aqaf102","type":"journal-article","created":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T11:57:35Z","timestamp":1756555055000},"page":"778-784","source":"Crossref","is-referenced-by-count":0,"title":["Anti\u2013platelet factor 4 testing for heparin-induced thrombocytopenia: Assessing the indication for its use for quality improvement as a patient safety measure"],"prefix":"10.1093","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3799-2595","authenticated-orcid":false,"given":"Hisham F","family":"Bahmad","sequence":"first","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben","family":"Delgado","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9919-7290","authenticated-orcid":false,"given":"Richard R","family":"Pacheco","sequence":"additional","affiliation":[{"name":"Department of Pathology, Albany Medical Center , Albany, NY ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei Shing","family":"Oh","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena P","family":"Rojas Gomez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esha","family":"Vallabhaneni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roshanak","family":"Azimi","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vathany","family":"Sriganeshan","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]},{"name":"Department of Pathology, Herbert Wertheim College of Medicine, Florida International University , Miami, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia","family":"Howard","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]},{"name":"Department of Pathology, Herbert Wertheim College of Medicine, Florida International University , Miami, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Poppiti","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]},{"name":"Department of Pathology, Herbert Wertheim College of Medicine, Florida International University , Miami, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Arkadi M. Rywlin, MD, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["United States"]},{"name":"Department of Pathology, Herbert Wertheim College of Medicine, Florida International University , Miami, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"2025111922464106700_CIT0001","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1182\/asheducation-2013.1.668","article-title":"Heparin-induced thrombocytopenia","volume":"2013","author":"Lee","year":"2013","journal-title":"Hematology Am Soc Hematol Educ Program."},{"key":"2025111922464106700_CIT0002","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.trsl.2020.04.014","article-title":"Pathogenesis of heparin-induced thrombocytopenia","volume":"225","author":"Arepally","year":"2020","journal-title":"Transl 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