Novel oral anticoagulants for heparin-induced thrombocytopenia

Abstract

To review the use of the novel oral anticoagulant (NOAC) agents for the treatment of heparin-induced thrombocytopenia (HIT) from relevant clinical trial data. A MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google-Scholar searches (1966-March 2016) were conducted using the keywords: thrombocytopenia, NOACs, dabigatran, apixaban, rivaroxaban, edoxaban, Xa inhibitor, direct thrombin inhibitor. Articles evaluating the new oral anticoagulants for thrombocytopenia published in English and using human subjects were selected. Eight clinical trials were identified. References cited in identified articles were used for additional citations. Approximately 12 million hospitalized patients each year are exposed to heparin for thromboprophylaxis. HIT, an immune-mediated, prothrombotic adverse reaction is a potential complication of heparin therapy. As a result, heparin products must be immediately withdrawn and replaced by alternative anticoagulants to compensate for the thrombotic risk associated with HIT. Limitations exist with the only currently FDA approved heparin alternative, argatroban. NOACs have been considered as potential alternatives to traditional agents based on their pharmacologic activity. Case reports have indicated positive results in patients, with clinical outcomes and tolerability supporting the use of the NOACs as alternative agents in the treatment of HIT. Positive results have been reported for the use of NOACs in the treatment of HIT. Further robust studies are needed for definitive decision making by clinicians.

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

“…(Earlier transition to VKA therapy is avoided because of increased risk of warfarin-induced microthrombosis during acute HIT. 3,7 ) Direct oral anticoagulants (DOACs) such as the direct factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) or the direct thrombin inhibitor dabigatran are attractive treatment options for HIT [8][9][10][11] for several reasons. First, there is no potentially deleterious immunologic interaction between these agents and HIT antibodies.…”

Extensive Intracardiac and Deep Venous Thromboses in a Young Woman with Heparin-Induced Thrombocytopenia and May-Thurner Syndrome

“…Clinical experience, though as yet limited, has shown good platelet count responses and tolerability in patients with HIT transitioned to NOAC, both directly after heparin discontinuation and after argatroban therapy [8, 9]. Our patient received a total of 10 days of argatroban therapy while hospitalized; her platelet count had recovered to 209K/ μ L when apixaban was started for lifelong anticoagulation given her risk for recurrent DVT.…”

Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico

“…Se han publicado series de casos de HIT manejados con rivaroxaban y dabigatran, siendo el primero el que concentra mayor número de casos 18 . En la revisión de Skelley y cols.…”

“…En la revisión de Skelley y cols. se reportan 12 casos de HIT tratados con rivaroxaban, sin nuevos eventos trombóticos ni sangrados 18 .…”