Treatment of Heparin-Induced Thrombocytopenia

Greinacher, Andreas

doi:10.1055/s-0037-1615866

Cited by 85 publications

(87 citation statements)

References 93 publications

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“…This triggers the generation of HIT antibodies. Almost always, there is an immunizing period that the patients are exposed to unfractionated and less commonly to low-molecular-weight heparin [73]. The recognition of PF4/HS complexes by antibodies leads to the formation of large immune complexes that cross-link the platelet FcγRIIa receptors, and this triggers platelet aggregation and formation of platelet-rich thrombosis [70,73].…”

Section: Heparin-induced Thrombocytopeniamentioning

confidence: 99%

The Significance and Management of Thrombocytopenia in Antiphospholipid Syndrome

2015

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The association between antiphospholipid antibodies (aPL) and clinical problems goes beyond what is stated in the antiphospholipid syndrome (APS) classification criteria, namely thrombosis and pregnancy morbidity, and thrombocytopenia is the most common non-criteria hematologic manifestation of aPL with a frequency ranging from 20 to 50 %. Thrombocytopenia is rarely severe, and hemorrhage is far less common than thrombosis. However, when anticoagulation is considered, it may constitute a clinical problem with increased bleeding risk. Furthermore, thrombocytopenia represents a risk factor for thrombosis in aPL-positive patients. Therefore, it is important to understand the pathogenesis and the clinical associations of thrombocytopenia to build the right medical approach in aPL-positive patients. In this paper, we review the literature on aPL/APS-associated thrombocytopenia and briefly discuss the other conditions that can result in thrombocytopenia as they have commonalities with APS and their recognition is important to establish the most appropriate treatment strategy.

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Section: Heparin-induced Thrombocytopeniamentioning

confidence: 99%

The Significance and Management of Thrombocytopenia in Antiphospholipid Syndrome

2015

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“…As a result, the risk for venous and/or arterial thrombosis is enhanced [8]. Current guidelines strongly recommend the use of the two DTIs, lepirudin and argatroban, or the use of danaparoid [3].…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban in the Treatment of Heparin-Induced Thrombocytopenia

Sartori

Favaretto

Cini

et al. 2015

J Thromb Thrombolysis

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Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition and it is associated with increased in vivo thrombin generation that needs to be treated with non-heparin anticoagulants such as direct thrombin inhibitors (DTIs). DTIs require parenteral administration and are associated with a non negligible risk of major bleeding. We describe a case of HIT treated with rivaroxaban, a direct oral factor Xa inhibitor which could be used to inhibit the generation of thrombin, instead of DTIs. A 68 year-old man with a thrombosis confined to the internal gastrocnemius and soleal veins developed HIT during enoxaparin 80 mg twice a day. Enoxaparin was stopped and rivaroxaban 20 mg once a day was started. Platelet count returned to base line after 6 days from enoxaparin withdrawal. After 3 months rivaroxaban was stopped and the patient had an uneventful course. This case report supports the hypothesis that rivaroxaban may be candidate for treatment of HIT, and larger studies are justified.

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“…As for the heparins, both unfractionated and LMWH which need to be administered parenterally, and carry a rare but severe risk of heparin-induced thrombocytopenia (HIP), requiring repeated monitoring of the platelet count [1,2]. To that end, these drawbacks have encouraged the development of several newer anticoagulant molecules [3].…”

Section: A Word Of Historymentioning

confidence: 99%

Newer anticoagulants in 2009

Samama

Gerotziafas

2009

J Thromb Thrombolysis

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Several newer anticoagulants are under clinical development. Recently two of them, Dabigatran etexilate/Pradaxa. and Rivaroxaban/Xarelto obtained marketing authorization in Europe and Canada for the prevention of thromboembolic events following major orthopedic surgery such as total hip and knee replacement. The results of Phase III clinical studies in thromboprophylaxis in major orthopedic surgery are highlighted and discussed in detail. Ongoing Phase II and III clinical trials assess their efficacy in the secondary prevention and treatment of deep vein thrombosis and pulmonary embolism, and in the long-term prevention of stroke in patients with non-valvular atrial fibrillation and in combination with aspirin and clopidogrel in patients with acute coronary syndromes. Many other small antithrombotic molecules including a new generation of low molecular weight heparins, are currently in different stages of clinical development. In addition to being administered orally, the newer anticoagulant agents have a more balanced benefit/risk ratio and wider therapeutic window. They have a rapid onset of action, a predictable anticoagulant effect that does not require routine laboratory monitoring. They have minor food and drug interactions, including those with cytochrome P450 and P.gp. They are highly specific and targeted to a single coagulation factor, and could carry similar or less hemorrhagic risks compared to the older anticoagulant agents. Finally, they may be used in a broader variety of patients, especially the medically ill patients with advanced cancer, and the elderly without any dosage adjustment, regardless of the patient age, gender, body weight, or in patients with mild renal impairment. Their use in the general world will hopefully confirm the promising results of clinical trials.

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Treatment of Heparin-Induced Thrombocytopenia

Cited by 85 publications

References 93 publications

The Significance and Management of Thrombocytopenia in Antiphospholipid Syndrome

The Significance and Management of Thrombocytopenia in Antiphospholipid Syndrome

Rivaroxaban in the Treatment of Heparin-Induced Thrombocytopenia

Newer anticoagulants in 2009

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