{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T21:01:24Z","timestamp":1785445284092,"version":"3.56.0"},"reference-count":12,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heparin induced thrombocytopenia (HIT) is often suspected among lung transplant recipients (LTRs) due to a high prevalence of thrombocytopenia and frequent heparin use. This study explores the utility of the 4Ts score in stratifying HIT risk among adult LTRs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>LTRs from a single large transplant center with post\u2010transplant platelet factor 4 (PF4) antibody testing between January 2020 and June 2024 were included in the analysis. The 4Ts score was calculated retrospectively, and the risk of HIT was classified as low (4Ts score \u22643), intermediate (4\u20135), or high (\u22656). The 4Ts risk classification was correlated with HIT laboratory testing results, with a positive serotonin release assay (SRA) representing confirmed HIT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 205 LTRs were included. The median 4Ts score was 2 (IQR 2\u20134), 153 patients (74.6%) were classified as low risk, and 52 (25.4%) were intermediate or high risk. Among low\u2010risk patients, none had confirmed HIT. In contrast, among intermediate or high\u2010risk patients, six had HIT (11.5%), representing an overall incidence of 2.9%. Using a low 4Ts score to rule out HIT would have averted 153 PF4 tests (75% of total), 17 SRA tests (50% of total), and nine orders for direct thrombin inhibitors (53% of total).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A low 4Ts score ruled out HIT among LTRs at our large transplant center. Incorporating the 4Ts clinical risk assessment into the diagnostic process may help avoid unnecessary HIT testing and use of alternative anticoagulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70396","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T11:41:17Z","timestamp":1763638877000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Heparin Induced Thrombocytopenia Risk Assessment: Investigating the Role of the 4Ts Score After Lung Transplantation"],"prefix":"10.1111","volume":"39","author":[{"given":"Nicole","family":"Unwin","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9736-0891","authenticated-orcid":false,"given":"Kellie J.","family":"Goodlet","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice Midwestern University College of Pharmacy  Glendale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josna","family":"Padiyar","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine Norton Thoracic Institute Dignity Health St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofya","family":"Tokman","sequence":"additional","affiliation":[{"name":"Division of Transplant Pulmonology Norton Thoracic Institute Dignity Health St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3207-9089","authenticated-orcid":false,"given":"Christine","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"},{"name":"Division of Transplant Pulmonology Norton Thoracic Institute Dignity Health St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6484-2480","authenticated-orcid":false,"given":"Rhiannon","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"},{"name":"Division of Transplant Pulmonology Norton Thoracic Institute Dignity Health St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1526924819892918"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239\u2010020\u201002249\u20107"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2012.11.2611"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024489"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102012\u201007\u2010443051"},{"key":"e_1_2_10_7_1","unstructured":"Heparin\u2010Induced Thrombocytopenia.Werfen North America. Retrieved May 27 2025 https:\/\/www.werfen.com\/na\/en\/hemosil\u2010reagents\/heparin\u2010induced\u2010thrombocytopenia."},{"key":"e_1_2_10_8_1","unstructured":"Heparin\u2010Induced Thrombocytopenia\u2014HIT. ARUP Consult\u00ae. Retrieved May 27 2025 https:\/\/arupconsult.com\/content\/heparin\u2010induced\u2010thrombocytopenia."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538\u20107836.2006.01787.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2023.06.033"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102023\u2010173542"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2022.04.007"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2021.04.057"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70396","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70396","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:39:12Z","timestamp":1785443952000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/ctr.70396"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70396","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2025-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70396"}}