Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia

Abstract

Heparin‐induced thrombocytopenia (HIT) is a potentially serious adverse drug reaction that can result in lethal vascular thrombosis. Dabigatran is a direct thrombin inhibitor that might be useful in the management of HIT. This study evaluated the efficacy and safety of dabigatran in patients with HIT. We included 43 patients in the study who received dabigatran for the management of suspected HIT, based on 4Ts (thrombocytopenia, timing of platelet count drop, thrombosis or other sequelae, and other causes of thrombocytopenia) scores. Three patients were excluded because they had received dabigatran with a creatinine clearance <15 mL/min. Patients’ records were analyzed longitudinally, with 12 months follow‐up from the time of initiation of dabigatran, for occurrence of thrombosis, dabigatran‐related complications, and outcome. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, active bleeding, and extremes of weights (<50 and >120 kg) were excluded from the study. Arterial thrombosis was not observed in any of our patients. The platelet counts normalized in all patients except for 2, which was attributed to the underlying comorbidities. We did not observe any hemorrhagic events or significant thrombosis during the follow‐up period. Eight patients died from nonthrombotic causes, which were unrelated to adverse effects of dabigatran. Based on our findings, dabigatran could be considered a safe and effective agent in the management of HIT, particularly in the developing countries, where there could be issues with the cost and availability of other agents recommended for this condition. Further studies are needed to validate our findings.

Rivaroxaban as an Alternative Agent for Heparin‐Induced Thrombocytopenia

“…15 In addition, Nasiripour et al reported the data on 40 patients who had received dabigatran for the treatment of suspected HIT based on 4Ts scores. 20 The normalization of platelet counts occurred in the case of all patients except for 2 cases that were related to the underlying conditions. Researchers did not detect any bleeding events or significant thrombosis during the 12month follow-up period.…”

“…7 In recent years the efficacy and safety of DOACs, counting the direct thrombin inhibitor (dabigatran) along with the direct factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), have been evaluated in the treatment of clinical pathological HIT. [14][15][16][17]20 Rivaroxaban, as a direct factor Xa inhibitor, may act as a therapeutic option for heparin-induced thrombocytopenia. Approved treatment options for HIT such as argatroban are used parenterally and require repetitive coagulation monitoring and dose adjustment.…”

“…Another oral apparent alternative option for HIT treatment is dabigatran. 14,15,17,20 Dabigatran is a prodrug that transforms to its active agent after ingestion and inhibits direct thrombin. As previously mentioned, Warkentin et al performed a study and literature review on the usage of DOACs for the management of HIT 15 in which 12 patients were treated by dabigatran.…”

“…Researchers did not detect any bleeding events or significant thrombosis during the 12month follow-up period. 20 Therefore, dabigatran could be considered a useful medicine for the treatment of HIT. However, comparison between the performance of dabigatran and rivaroxaban in the management of HIT has not yet been reported in the available literature.…”

Update on Mechanisms, Pathogenicity, Heterogeneity of Presentation, and Laboratory Diagnosis of Heparin-Induced Thrombocytopenia

“…The patient's clinical context can favor the development of this iatrogenic complication, called heparin-induced thrombocytopenia (HIT) without or with associated thrombosis (HITT). When this complication occurs, it requires an immediate management with the withdrawal of heparin and use of an alternative anticoagulant [7][8][9][10][11]. If incorrectly managed, it can rapidly cause severe burden and become life-threatening.…”