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Heparin-induced thrombocytopenia (HIT) is a common but often unrecognized complication of heparin therapy that has been linked to devastating outcomes if it fails to be treated promptly and properly. Heparin use is ubiquitous in hospitals; an estimated 12 million people in the United States—one-third of all hospitalized patients—will have some heparin exposure each year, and published studies indicate that HIT develops in up to 5% of all patients receiving heparin. Accordingly, consensus guidelines recommend monitoring, timely recognition of signs and symptoms, and rapid initiation of treatment to limit morbidity and mortality associated with HIT.

It behooves all clinicians to increase their awareness of HIT, be vigilant for the disease, and learn how to intervene properly. HIT should be regarded as a limb- and life-threatening condition, and care for these patients needs to occur with urgency. Fortunately, efforts continue to help close the gap between HIT clinical practice guidelines and actual practice through the creation and implementation of standardized treatment protocols.

The Need for a New ICD-9 Code

Recently, a new five-digit sub-classification ICD-9 code was established to provide better clarity on HIT. Prior to this change, HIT was lumped together with secondary thrombocytopenias, but these diseases are disparate. HIT was included with thrombocytopenias due to other drugs, infection and sepsis, and other miscellaneous conditions. The problem with previous ICD-9 coding is that HIT is unique from all these other thrombocytopenias. For example, the primary concern with most thrombocytopenias is typically bleeding, and if thrombocytopenia is severe, platelet transfusions are considered. This is problematic in HIT because bleeding is not the primary concern; rather it’s clotting and thrombosis, and platelet transfusions in HIT can worsen the situation.

Categorizing HIT with other drug-induced thrombocytopenias is also problematic because frequently the only form of treatment needed for these cases would be to stop the offending drug. With HIT, stopping heparin is not adequate therapy because an extreme risk for blood clots persists for several weeks. Clinicians should understand that HIT patients require the urgent administration of an alternative anticoagulant to heparin.

New Coding Will Yield Great Benefits

The primary goal of creating an ICD-9 code for HIT is to improve patient outcomes, and the new code should greatly impact awareness of the problem. Now that it has a unique ICD-9 code, physicians and hospitals will need to become more aware of HIT so that coding can be done properly for reimbursement. Furthermore, having the new ICD-9 code will greatly facilitate the ability to collect data on HIT. Many questions have yet to be answered regarding the true incidence of HIT in various settings, including medical ICUs and during cardiac surgeries. The code will also facilitate the collection of data on HIT-related complications and cost, and impact possible prevention measures.

Ultimately, the hope is that the new ICD-9 coding for HIT will aid more widespread adoption of aggressive prevention, monitoring, and treatment strategies. Physician awareness needs to extend beyond an improved recognition of the disease. Also, a greater appreciation of risk is needed; physicians should embrace the notion that the potentially catastrophic consequences of HIT can be minimized. It will require collective actions from the entire medical community to implement initiatives that minimize the dangers associated with heparin.

Lawrence Rice, MD has indicated to Physician’s Weekly that he has been a consultant for GlaxoSmithKline, The Medicines Company, Sanofi-Aventis, and Canyon Pharmaceuticals. He has also worked as a paid speaker for GlaxoSmithKline.