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4Ts score for heparin-induced thrombocytopenia

Pre-test probability of HIT.

4Ts score for heparin-induced thrombocytopenia
Thrombocytopenia (magnitude of platelet fall)
Timing of platelet fall
Thrombosis or other sequelae
Other cause for thrombocytopenia
Result0 points

Low pre-test probability of HIT (about ~3%). A low score has a high negative predictive value.

Probability
Low
Approx. HIT likelihood
~3%

When to use

  • Estimating the likelihood of heparin-induced thrombocytopenia before ordering immunoassays or functional testing.

Formula

0-2 points each for Thrombocytopenia, Timing, Thrombosis and oTher cause. Range 0-8; low 0-3, intermediate 4-5, high 6-8.

Pearls and pitfalls

  • A low score reliably excludes HIT and usually avoids the need to stop heparin.
  • Confirm intermediate/high scores with a functional assay.

References

  1. Lo GK, et al. J Thromb Haemost. 2006;4(4):759-765.