Heparin-induced thrombocytopenia: Pathophysiology and new treatment options

Harenberg, Job; Jörg, I.; Fenyvesi, T

doi:10.1159/000073583

Cited by 16 publications

(22 citation statements)

References 23 publications

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“…These antibodies subsequently activate platelets through their Fc receptors, causing the release of prothrombotic platelet-derived microparticles, which in turn promote thrombin generation and contribute to a hypercoagulable state. [5][6][7][8] HIT has been reported to occur in approximately 1% to 3% of all patients receiving unfractionated heparin products, and if it is not recognized, thrombosis (arterial, venous, or both) can occur in up to 50% of patients with thrombosis-related deaths ranging from 5% to 10%. 1,2,9,10 HIT is suspected clinically in the setting of recent or current heparin exposure if thrombocytopenia and/or thrombosis develop.…”

Section: Introductionmentioning

confidence: 99%

Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score–matched study

Kang

Alahmadi

Sawh

et al. 2015

Blood

111

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Key Points• Fondaparinux seems to be an effective and safe alternative for the management of suspected HIT.Current guidelines for heparin-induced thrombocytopenia (HIT) management recommend heparin cessation and switching to a nonheparin anticoagulant (ie, argatroban, danaparoid) upon clinical suspicion. Fondaparinux may be effective but information supporting its use is limited. We retrospectively evaluated 239 patients who received a nonheparin anticoagulant (fondaparinux 5 133, danaparoid 5 59, and argatroban 5 47) for suspected or confirmed HIT. A propensity score was constructed based on age, gender, creatinine, 4T scores, and comorbidity index, and used to match 133 patients to 60 controls. Outcomes were thrombosis or thrombosis-related death and major bleeding. In the matched population there were 22 (16.5%) episodes of thromboses in the fondaparinux group and 13 (21.4%) in the control group (x 2 P 5 .424). Bleeding was observed in 28 (21.1%) patients in the fondaparinux group compared with 12 (20%) in the control group (x 2 P 5 .867). Survival analysis, and subgroup and unmatched analyses showed similar results. In the fondaparinux group, 60% of patients received prophylactic doses. Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists. (Blood. 2015;125(6):924-929)

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Section: Introductionmentioning

confidence: 99%

Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score–matched study

Kang

Alahmadi

Sawh

et al. 2015

Blood

111

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…For this reason it is expected not to act as a potent protein binding hapten [8]. Therefore, it does not ineract with heparin-PF4 complexes, and the formation of a sensitizing complex resulting in an HIT II is not possible [8]. In severe bleeding under anticoagulation with fondaparinux, recombinant factor VIIa seems to be appropriate in reversing the anticoagulant effect of fondaparinux [9].…”

Section: Discussionmentioning

confidence: 99%

Use of fondaparinux (ARIXTRA(R)) in a dialysis patient with symptomatic heparin-induced thrombocytopaenia type II

Haase¹,

Bellomo²,

Rocktaeschel³

et al. 2005

Nephrology Dialysis Transplantation

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“…Argatroban is now widely used in patients with HIT and its thrombotic complications [68,[110][111][112][113][114][115][116][117]. Compared with lepirudin, argatroban is more effective and safer in the management of HIT [68] in patients undergoing CABG surgery [72,[117][118][119][120], adult extracorporeal membrane oxygenation alone [121], CPB in infants [122] and children [123], and in patients with acute coronary syndromes [124].…”

Section: Argatrobanmentioning

confidence: 99%