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dc.contributor.advisorWalton, Surrey M.en_US
dc.contributor.authorPatel, Vardhamanen_US
dc.date.accessioned2015-10-21T14:18:00Z
dc.date.available2017-10-22T09:30:15Z
dc.date.created2015-08en_US
dc.date.issued2015-10-21
dc.date.submitted2015-08en_US
dc.identifier.urihttp://hdl.handle.net/10027/19794
dc.description.abstractHeparin-induced thrombocytopenia (HIT) is an immunologic response to heparin exposure that may lead to thrombosis. Argatroban and bivalirudin are two commonly used direct thrombin inhibitors (DTIs) for the prevention of thrombosis in patients with HIT. However, DTIs may lead to major bleeding events. Data on the use and consequences of DTIs is limited. Of note, patients with suspected HIT are of interest in the thesis, as current guidelines recommend the initiation of DTI treatment at the time of clinical suspicion of HIT. This thesis focused on the identification of suspected HIT, and the use and consequences of direct thrombin inhibitors (DTI) for the treatment of suspected HIT. First, algorithms based on diagnostic codes, medications and diagnostic tests were developed and validated to identify patients with suspected HIT. An algorithm based only on the timing of medication and diagnostic tests was recommended for the identification of suspected HIT from claims data, as it was observed to have the highest positive predictive value and sensitivity. Second, the rates of thrombosis, major bleeding, amputation and mortality were compared between argatroban-treated and bivalirudin-treated patients using administrative claims data obtained from the University HealthSystem Consortium. The difference in the likelihood of thrombosis, amputation and mortality between the two DTI groups was not statistically significant. However, bivalirudin-treated patients were more likely to experience major bleeding than argatroban-treated patients. Third, the use of bivalirudin for the treatment of suspected HIT (off-label use) increased from one-third to half of DTI-treated patients from 2010 to 2012. Patients treated by surgeons or specialists were more likely to receive off-label bivalirudin compared to patients treated by primary care. In addition, hepatic impairment and skin infection increased the odds of patients to receive bivalirudin over argatroban. In conclusion, the off-label use of bivalirudin should be scrutinized for medical necessity due to the higher risk of bleeding than argatroban, except in patients with hepatic impairment.en_US
dc.language.isoenen_US
dc.rightsen_US
dc.rightsCopyright 2015 Vardhaman Patelen_US
dc.subject1en_US
dc.subjectcomparative effectivenessen_US
dc.subject2en_US
dc.subjectdirect thrombin inhibitorsen_US
dc.subject3en_US
dc.subjectargatrobanen_US
dc.subject4en_US
dc.subjectbivalirudinen_US
dc.subject5en_US
dc.subjectthrombosisen_US
dc.subject6en_US
dc.subjectmajor bleedingen_US
dc.subject7en_US
dc.subjectsafetyen_US
dc.subject8en_US
dc.subjectoff-labelen_US
dc.subject9en_US
dc.subjectalgorithmsen_US
dc.subject10en_US
dc.subjectvalidityen_US
dc.titleDirect Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopeniaen_US
thesis.degree.departmentPharmacy Systems, Outcomes and Policyen_US
thesis.degree.disciplinePharmacy Systems, Outcomes and Policyen_US
thesis.degree.grantorUniversity of Illinois at Chicagoen_US
thesis.degree.levelDoctoralen_US
thesis.degree.namePhD, Doctor of Philosophyen_US
dc.type.genrethesisen_US
dc.contributor.committeeMemberSchumock, Glen T.en_US
dc.contributor.committeeMemberLee, Todd A.en_US
dc.contributor.committeeMemberGalanter, William L.en_US
dc.contributor.committeeMemberNutescu, Edith A.en_US
dc.contributor.committeeMemberHohmann, Samuel F.en_US
dc.type.materialtexten_US


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