Dabigatran como posibilidad terapéutica en el síndrome de trombocitopenia inducida por heparina tipo II

Anniccherico, F. J.; Alonsó, José Luis; Urbieta, M.; Ricarte, S. Pérez

doi:10.4321/s1137-66272012000300024

Cited by 12 publications

(3 citation statements)

References 9 publications

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“…35,36 In 25% of observed reports, however, apparently effective anticoagulation was carried out with direct initiation of DOAC-based anticoagulation, even in patients with HIT and other hypercoagulable conditions such as prothrombin 20210A, MTHFR, Essential Thrombocytosis, and active malignancy. [31][32][33] As studied in clinical trials and recommended in their respective package inserts, a lead-in period with parenteral anticoagulation is utilized during treatment of acute VTE with dabigatran or edoxaban. Conversely, rivaroxaban and apixaban trials did not employ a lead-in period with parenteral therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In another case report, dabigatran treatment was associated with rapid reversal of HIT-related thrombosis in a patient with essential thrombocythemia. 32 Tardy-Poncet and colleagues present an interesting case of a patient with remote (>100 days) heparin exposure who developed thrombocytopenia upon exposure to heparinized autotransfusion product during orthopedic surgery; there were no other heparin exposures. 28 Postoperative thromboprophylaxis was initiated with daily rivaroxaban (10 mg) started 8 hours following wound closure after right knee replacement and continued through day 21.…”

Section: Dabigatranmentioning

confidence: 99%

“…In another case report, dabigatran treatment was associated with rapid reversal of HIT-related thrombosis in a patient with essential thrombocythemia. 32…”

Section: Dabigatranmentioning

confidence: 99%

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Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

Tran

2017

Clin Appl Thromb Hemost

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Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) are rare but potentially limb- and life-threatening complications of heparin therapy. Continuation of heparin or low-molecular-weight heparin is contraindicated due to platelet activation in the presence of (heparin-dependent) HIT antibodies. Primary treatment options currently include argatroban, fondaparinux, or bivalirudin. However, the parenteral administration routes and interference of argatroban with traditional coagulation markers complicate management. The goal of this review is to assess the viability of direct oral anticoagulants as an alternative treatment option in patients with HIT/HITT. Their use in HIT/HITT is reasonable, given absent cross-reactivity preformed with HIT antibodies. Furthermore, their rapid onset of action and induction of effective anticoagulation provide a favorable basis for their use in this condition. Herein, we summarize 3 studies and 8 case reports comprising 56 patients in whom direct oral anticoagulants were used in the treatment of HIT/HITT.

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Section: Discussionmentioning

confidence: 99%

Section: Dabigatranmentioning

confidence: 99%

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Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

Tran

2017

Clin Appl Thromb Hemost

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Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia

Nasiripour

Saif

Farasatinasab

et al. 2018

The Journal of Clinical Pharma

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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.

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Potential Role of Direct Oral Anticoagulants in the Management of Heparin‐induced Thrombocytopenia

Barlow

Reinaker

et al. 2019

Pharmacotherapy

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Heparin‐induced thrombocytopenia (HIT) is a rare, potentially life‐threatening condition secondary to unfractionated heparin or low molecular weight heparin exposure. This immune‐mediated drug reaction manifests as thrombocytopenia with a paradoxical hypercoagulable state that can result in life‐threatening thrombosis. It is imperative to ensure cessation of heparin‐based products as soon as HIT is identified. Traditional treatment options include argatroban, bivalirudin, fondaparinux, and danaparoid with a transition to warfarin upon platelet recovery. These anticoagulants are notwithstanding limitations including parenteral administration and routine laboratory monitoring leading to prolonged hospitalizations, emphasizing the need for new therapies. Direct oral anticoagulants (DOACs) have been increasingly investigated for the management of HIT and may overcome the aforementioned challenges of current therapies. The objective of this narrative review is to summarize the current HIT guidelines, discuss limitations to contemporary treatment options, provide insight into the emerging evidence for the DOACs rivaroxaban, apixaban, and dabigatran, and conclude with a clinical summary for their use in this setting. The PubMed, Google Scholar, and MEDLINE databases were searched for peer‐reviewed literature from January 1, 2012, to June 31, 2018. Twenty‐seven articles met inclusion criteria for review: 1 prospective trial, 5 retrospective cohort studies, and 21 case reports totaling 104 patients treated with a DOAC for HIT. The DOACs prevented new and recurrent thrombosis in 98% (n=102) of cases, and bleeding complications occurred in 3% (n=3). While current literature remains limited, it is suggestive of a potential role of DOACs for HIT, which has led to their integration into the 2018 American Society Hematology Guidelines with a conditional recommendation.

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Dabigatran como posibilidad terapéutica en el síndrome de trombocitopenia inducida por heparina tipo II

Cited by 12 publications

References 9 publications

Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia

Potential Role of Direct Oral Anticoagulants in the Management of Heparin‐induced Thrombocytopenia

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