Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review

Warkentin, Theodore E.; Pai, Menaka; Linkins, Lori‐Ann

doi:10.1182/blood-2017-04-778993

Cited by 165 publications

(154 citation statements)

References 52 publications

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“…Among the 12 patients who received dabigatran for HIT management, only 1 patient had a possible thrombotic event while receiving a DOAC (multiple strokes, which might have been present before starting dabigatran). None of the patients experienced major hemorrhagic events …”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia

Nasiripour

Saif

Farasatinasab

et al. 2018

The Journal of Clinical Pharma

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“…Despite the low quality of evidence, fondaparinux has still gained wide‐spread acceptance as a treatment option for HIT 6. A similar phenomenon is currently happening with direct oral anticoagulants (DOACs) 29. Oral administration gives DOACs an advantage over fondaparinux, however, there will always be a role for a parenteral agent that can be given to HIT patients who are too sick to take oral agents.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of fondaparinux for heparin‐induced thrombocytopenia: When there are no randomized controlled trials

Linkins

Warkentin

2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundFondaparinux is commonly used for treatment of heparin‐induced thrombocytopenia (HIT) despite lack of approval for this indication. High quality randomized controlled trials of this agent are unlikely to be forthcoming.ObjectivesThe objective of this systematic review is to update the literature on the efficacy and safety of fondaparinux for treatment of confirmed and probable HIT based on the available evidence.MethodsPrimary articles were identified using Web of Science and PubMed database searches for English‐language studies from January 2006 to November 2017. Selected studies enrolled consecutive adult patients who received fondaparinux as the primary anticoagulant to treat acute HIT; confirmed the diagnosis by serological testing with a serotonin‐release assay; heparin‐induced platelet activation assay or enzyme‐linked immunosorbent assay; provided clinical criteria used to define HIT and reported clinically important outcomes.ResultsA total of 9 studies were identified with 154 HIT positive patients. Ten experienced a new thrombotic event while receiving fondaparinux (6.5%, 95% CI, 3.4 to 11.7%) and 26 experienced major bleeding (16.9%, 95% CI, 11.7 to 23.6%). Mortality due to thrombosis or bleeding was reported in 5 patients (3.2%, 95% CI, 1.2 to 7.6%).ConclusionsFondaparinux appears to be an effective and safe anticoagulant for treatment of acute HIT despite the absence of randomized trials. Caution should exercised when using fondaparinux in patients with renal insufficiency.

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“…A recent literature review suggested that DOACs are highly efficacious in this scenario, although most patients included in the report were treated with rivaroxaban 3. Among DOACs, apixaban is the least dependent on renal clearance of the direct factor Xa inhibitors and might be the one with the smallest bleeding risk 4.…”

Section: Discussionmentioning

confidence: 99%