Apixaban therapy in a pregnant woman with heparin-induced thrombocytopenia and venous thromboembolic events caused by congenital antithrombin deficiency: A case report

Komori, Mayuko; Hayata, Eijiro; Nakata, Masahiko; Yuzawa, Hitomi; Oji, Ayako; Morita, Mineto

doi:10.1016/j.crwh.2020.e00200

Cited by 8 publications

(12 citation statements)

References 7 publications

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“…1 However, studies in this area are more limited to case reports and retrospective studies. 7,8,[13][14][15][16][17][18]27 Apixaban, as a direct factor Xa inhibitor, may be a therapeutic agent for HIT. In contrast, direct thrombin inhibitors are administered intravenously as continuous titratable infusions and need repetitive coagulation monitoring and dose adjustment; apixaban is used orally with predefine fixed dosing and does not require routine coagulation monitoring and has the smallest renal clearance compared with other DOACs.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that apixaban could be an appropriate agent for anticoagulant therapy in pregnant women with a history of HIT. 18 In line with previous studies, we designed this first pilot intervention study to evaluate the safety and efficacy of predefined doses of apixaban in patients with suspected HIT based on 4Ts scores. Our results indicated that apixaban could be a safe and effective agent in the management of HIT.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, some guidelines suggest the use of DOACs in the treatment of clinical‐pathological HIT 1 . However, studies in this area are more limited to case reports and retrospective studies 7,8,13–18,27 …”

Section: Discussionmentioning

confidence: 99%

“…Some studies showed that apixaban could be effective and safe medicine in the treatment of HIT. 7,[13][14][15][16][17][18] We undertook this open-label, single-arm, pilot intervention study to assess the efficacy and safety of apixaban in the management of HIT.…”

mentioning

confidence: 99%

“…Therefore, apixaban may be an ideal possible alternative for the treatment of HIT in a patient with or without renal impairment. Some studies showed that apixaban could be effective and safe medicine in the treatment of HIT 7,13–18 . We undertook this open‐label, single‐arm, pilot intervention study to assess the efficacy and safety of apixaban in the management of HIT.…”

mentioning

confidence: 99%

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An Open‐Label, Single‐Arm, Pilot Intervention Study to Assess the Efficacy and Safety of Apixaban in Heparin‐Induced Thrombocytopenia

Farasatinasab

Baloochzehi

Moghamddam

et al. 2022

The Journal of Clinical Pharma

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Heparin‐induced thrombocytopenia (HIT) is a serious adverse drug reaction due to its related risk of life‐ and limb‐threatening thrombosis. Apixaban is a direct factor Xa inhibitor that may be intended as an ideal alternative for the management of HIT. In this open‐label, single‐arm, pilot intervention study, the efficacy and safety of apixaban were evaluated in 30 patients aged >18 years with clinically suspected HIT (4Ts score ≥4 points). Patients with mechanical heart valves, chronic kidney disease, hepatic impairment, and active bleeding were excluded. In all patients with inclusion criteria, heparin or enoxaparin was discontinued and apixaban was started. The dose of apixaban for HIT suspected patients was defined on the basis of the reason for anticoagulant therapy. End points included confirmed thrombosis, mortality, and adverse treatment‐related events. After apixaban therapy, platelet counts normalized in all patients; none of the 30 subjects developed new, progressive, or recurrent thrombosis; and only 1 of 30 patients developed a hemorrhagic event. Five patients (16.7%) died, but the reason for death was not linked to thrombosis, hemorrhage, or adverse effects of apixaban. Along with the available emerging data, our results propose that apixaban could be a safe and effective drug for the management of suspected HIT in clinically stable patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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An Open‐Label, Single‐Arm, Pilot Intervention Study to Assess the Efficacy and Safety of Apixaban in Heparin‐Induced Thrombocytopenia

Farasatinasab

Baloochzehi

Moghamddam

et al. 2022

The Journal of Clinical Pharma

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Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review

Nekooghadam,

Ebrahimi‐Dehkordi,

Paraandavaji

et al. 2023

Clinical Case Reports

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The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low‐molecular‐weight heparin. Heparin‐induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6‐week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy‐related HIT. HIT is a pro‐coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.

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Schwangere in der Intensivmedizin

Bohlmann¹

2022

Die Intensivmedizin

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Apixaban therapy in a pregnant woman with heparin-induced thrombocytopenia and venous thromboembolic events caused by congenital antithrombin deficiency: A case report

Cited by 8 publications

References 7 publications

An Open‐Label, Single‐Arm, Pilot Intervention Study to Assess the Efficacy and Safety of Apixaban in Heparin‐Induced Thrombocytopenia

An Open‐Label, Single‐Arm, Pilot Intervention Study to Assess the Efficacy and Safety of Apixaban in Heparin‐Induced Thrombocytopenia

Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review

Schwangere in der Intensivmedizin

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