Rivaroxaban as an Alternative Agent for Heparin‐Induced Thrombocytopenia

Abstract

Heparin‐induced thrombocytopenia (HIT) is a high‐risk adverse drug reaction because of its associated risk of life‐ and limb‐threatening thrombosis. Rivaroxaban may be considered as an ideal nonheparin anticoagulant alternative for the management of HIT. In this preliminary retrospective study, the efficacy and safety of rivaroxaban to control the clinically suspected HIT (4Ts score 4 points or greater) were evaluated. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, and active bleeding were excluded. Forty‐two eligible patients who received rivaroxaban for clinically suspected HIT were evaluated by medical records review, with 12‐month follow‐up after the first dose of rivaroxaban. End points included confirmed thrombosis (primary end point), mortality, and adverse treatment‐related events. HIT‐associated thrombosis was found in 17/42 (40.5%) patients before receiving rivaroxaban. After rivaroxaban therapy, platelet counts normalized in all patients, with only 1/42 (2.3%) patients developing new thrombosis. No hemorrhagic event was recorded in the patients. Twelve patients (28.6%) died, but the cause of death was not related to the thrombosis, hemorrhage, or adverse effects of rivaroxaban. Our findings are consistent with the available emerging data, suggesting that rivaroxaban is a safe and effective drug for the management of clinically suspected HIT. Rivaroxaban is a particularly valuable treatment option in developing countries, where there are issues of cost and availability of approved alternative agents.

Structural Features and PF4 Functions that Occur in Heparin-Induced Thrombocytopenia (HIT) Complicated by COVID-19

“…To rescue patients from fondaparinuxcross reactive or fondaparinux-refractory HIT, high-dose intravenous immunoglobulin (IVIG) was clinically used [45]. Switching blood thinners to rivaroxaban is considered safe and effective for the management of clinically suspected HIT [46].…”

Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia

“…Of these, 309 were excluded because no new data were given ( n = 130), insufficient clinical data reported ( n = 44), double publication ( n = 81), case reports only ( n = 9), or used an investigational therapy other than one of the pre‐specified anticoagulants ( n = 45). Ninety‐two articles reporting on 4698 patients in 119 study groups were eventually included 20‐111 . A flow‐diagram of the articles is illustrated in Figure 1.…”

A case of severe COVID-19 with pulmonary thromboembolism related to heparin-induced thrombocytopenia during prophylactic anticoagulation therapy

“…For the treatment of reported HIT cases in COVID-19, parenteral anticoagulants such as argatroban are frequently used, and most oral anticoagulants such as DOACs are used after bridging with the parenteral anticoagulants as necessary [ 6 , 18 , 20 ]. The use of DOACs as alternative anticoagulants in HIT has been increasingly reported during recent years [ 21 ]. Directly switching to DOACs for HIT appears to be effective in clinically stable patients, as in our case.…”