Bivalirudin for anticoagulation in mechanical aortic valve replacement and heparin-induced thrombocytopenia

Klein, Moti; Tomer, Aaron; Swartz, Andre; Koyffman, Leonid; Weksler, Natan

doi:10.1097/01.mbc.0000224857.73119.97

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…An alternative to selecting fondaparinux as the parenteral bridging agent would have been selection of a direct thrombin inhibitor (DTI). There have been some published case reports on the use of DTIs in patients with mechanical heart valves whose medical course was complicated by HIT [11,12]. Yet, the literature supporting DTI use in such patients is quite limited.…”

Section: Discussionmentioning

confidence: 96%

Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia

Corbett

Elher

Garwood

2010

J Thromb Thrombolysis

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The development of heparin-induced thrombocytopenia (HIT) is an antibody-mediated clinicopathologic syndrome. The resultant thrombocytopenia and thrombosis can be severe and life-threatening. Fondaparinux is a parenteral factor Xa inhibitor used for venous thromboembolism prevention and treatment. Fondaparinux has minimal affinity for platelet factor 4, making it an alternative agent to unfractionated heparin (UFH) and low-molecular weight heparin (LMWH) and a plausible consideration for patients with a history of HIT. The use of fondaparinux in patients with mechanical heart valve replacement and a history of HIT has never been discussed in the literature. We report on the case of a patient with a mechanical aortic heart valve replacement and a history of HIT who was successfully bridged postoperatively with fondaparinux. While there is currently no literature to support the use of fondaparinux in patients with mechanical heart valves, this drug may offer an option for management of such patients who cannot use heparin products. However, further clinical investigations are warranted to confirm both the safety and efficacy of this agent in the mechanical heart valve population.

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Section: Discussionmentioning

confidence: 96%

Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia

Corbett

Elher

Garwood

2010

J Thromb Thrombolysis

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“…One hundred and three unique case reports were identified: 47 in the manufacturer's data base, 55 in 21 independent publications [3,15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and 1 in a marketing brochure.…”

Section: Resultsmentioning

confidence: 99%

Is Danaparoid Anticoagulation Suitable for Patients with HIT and ARF Requiring CVVRT? An Analysis of Case Reports

Jpj¹

2012

J Biom Biostat 2012

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Purpose: To assess the efficacy and safety outcomes of case reports of danaparoid anticoagulation in critically ill ICU patients suffering from HIT who require CRRT. Method:A retrospective analysis of 103 cases.Results: Based on clinical signs, pre-treatment 4T scores and serological testing, HIT was reasonably 'confirmed' in 67.0% of the cases and 'suspected' in the remainder. The patients, with HIT and ARF received the danaparoid treatment regimen for CRRT for 1-39 (median 7) days. Dose adaptation was necessary in 40.2% of the patients to overcome thrombosis or bleeding (risk). Satisfactory CRRT anticoagulation was provided for 93.6% of 94 cases with information, 53.9% of the patients survived. The hospital mortality of 46.1% was mainly attributed to concomitant morbidity, but 5 deaths were related to thrombosis (n=2) or bleeding (n=3). Maintenance plasma anti-Xa activity correlated poorly with bleeding or thrombotic complications but positively with the minor bleeding frequency, hence advice to restrict the upper limit to 0.8 U/mL or preferably to use evidence of bleeding and systemic thrombosis/ circuit clotting to judge the need for dose adaptation. The benefit (no thrombosis)/harm (bleeding induction) ratio and combined inefficacy and major haemorrhagic frequency were 10.5 and 16.6% respectively, showing a generally favourable response to danaparoid. Conclusions:This case report analysis shows that danaparoid, despite its renal elimination, long half-life and lack of antidote, appears to provide efficacious and safe anticoagulation for the majority of critically ill patients with HIT and ARF who are undergoing CRRT.

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“…Nevertheless, there is scarce literature about bivalirudin use in prosthetic valves in settings outside of CPB or for longer time periods. There is a case report about the use of bivalirudin as standalone anticoagulant for three days in a patient with an aortic mechanical valve suffering from heparin‐induced thrombocytopenia but this regimen has not been previously reported for use in patients with mechanical mitral valves.…”

Section: Discussionmentioning

confidence: 99%

Bivalirudin for Prevention of Prosthetic Valve Thrombosis in Heparin Allergy

2013

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Bivalirudin for anticoagulation in mechanical aortic valve replacement and heparin-induced thrombocytopenia

Cited by 6 publications

References 17 publications

Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia

Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia

Is Danaparoid Anticoagulation Suitable for Patients with HIT and ARF Requiring CVVRT? An Analysis of Case Reports

Bivalirudin for Prevention of Prosthetic Valve Thrombosis in Heparin Allergy

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