SynthesisBlood2012
Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis.
Synthesis in Blood, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 165 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
165 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach From the Writing Committee of the American Society for Apheresis: The Tenth Special Issue.Journal of clinical apheresis · 2026Guideline
- Safety and efficacy of fondaparinux use in hemodialysis patients with heparin-induced thrombocytopenia: a systematic review.European journal of clinical pharmacology · 2025Pooled it
- Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review.International journal of clinical pharmacy · 2021Pooled it
- American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia.Blood advances · 2018Guideline
- STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass.The journal of extra-corporeal technology · 2018Guideline
- Diagnostic accuracy of IgG-specific versus polyspecific enzyme-linked immunoassays in heparin-induced thrombocytopenia: a systematic review and meta-analysis.Journal of thrombosis and haemostasis : JTH · 2017Pooled it
- Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial.Critical care (London, England) · 2014Trial
- Development of an integrated clinical-laboratory scoring system for accurate HIT diagnosis.Blood advances · 2026Article
- [Analysis of Clinical Characteristics and Diagnostic Indicators in Patients With Heparin-induced Thrombocytopenia After Cardiac Surgery].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2026Article
- Ultra-Low Dose Argatroban in Heparin-Induced Thrombocytopenia with Thrombocytopenia and Hypofibrinogenemia: A Case Report.TH open : companion journal to thrombosis and haemostasis · 2026Article
- Tirofiban-Associated Profound Thrombocytopenia in a Patient With Glucose-6-Phosphate Dehydrogenase Deficiency Undergoing Primary Percutaneous Coronary Intervention: A Case Report.Case reports in cardiology · 2026Article
- Spinal intradural hematoma after intrathecal drug delivery system implantation in a patient with possible heparin-induced thrombocytopenia: a case report.Frontiers in oncology · 2026Article
- Dynamic platelet profiles in the emergency department and their predictive value for 28-day all-cause mortality in septic patients.PloS one · 2026Article
- Possible atypical heparin-induced thrombocytopenia presenting with splenic infarction despite preserved platelet counts after cardiac surgery - a case report.Frontiers in medicine · 2026Article
- Inter-Observer Agreement and Laboratory Correlation of the 4T Scoring Model for Heparin-Induced Thrombocytopenia: A Single-Center Retrospective Study and Literature Review.Journal of clinical medicine · 2025Article
- Article
- The Differential Diagnosis of Thromobocytopenia.Deutsches Arzteblatt international · 2025Review
- Type II heparin-induced thrombocytopenia in a maintenance hemodialysis patient: A case report and literature review.Medicine · 2025Review
- Anti-PF4 disorders: Pathogenesis, diagnosis and treatment.British journal of haematology · 2025Review
- Article
105 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
The 4Ts is a pretest clinical scoring system for heparin-induced thrombocytopenia (HIT). Although widely used in clinical practice, its predictive value for HIT in diverse settings and patient populations is unknown. We performed a systematic review and meta-analysis to estimate the predictive value of the 4Ts in patients with suspected HIT. We searched PubMed, Cochrane Database, and ISI Web of Science for studies that included patients with suspected HIT, who were evaluated by both the 4Ts and a reference standard against which the 4Ts could be compared. Quality of eligible studies was assessed by QUADAS-2 criteria. Thirteen studies, collectively involving 3068 patients, fulfilled eligibility criteria. A total of 1712 (55.8%) patients were classified by 4Ts score as having a low probability of HIT. The negative predictive value of a low probability 4Ts score was 0.998 (95% CI, 0.970-1.000) and remained high irrespective of the party responsible for scoring, the prevalence of HIT, or the composition of the study population. The positive predictive value of an intermediate and high probability 4Ts score was 0.14 (0.09-0.22) and 0.64 (0.40-0.82), respectively. A low probability 4Ts score appears to be a robust means of excluding HIT. Patients with intermediate and high probability scores require further evaluation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.