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

Haase, Michael; Bellomo, Rinaldo; Rocktaeschel, Jens; Ziemer, Sabine; Kiesewetter, H.; Morgera, Stanislao; Neumayer, Hans H.

doi:10.1093/ndt/gfh544

Cited by 58 publications

(40 citation statements)

References 10 publications

(9 reference statements)

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“…[158][159][160] The evidence regarding the use of fondaparinux is limited to case reports. 161,162 In summary, there is no direct evidence supporting the use of one alternative nonheparin anticoagulant over another in patients with acute HIT who require renal replacement therapy. There has been more experience with danaparoid than argatroban for this indication; however, although the highest level of evidence supporting the use of danaparoid comes from comparative studies in patients without HIT, the use of argatroban is supported by prospective data (albeit limited) and pharmacokinetics (ie, lack of renal clearance).…”

Section: Lepirudin (Recombinant Hirudin)mentioning

confidence: 99%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Moores

et al. 2012

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Section: Lepirudin (Recombinant Hirudin)mentioning

confidence: 99%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Dans

Moores

et al. 2012

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849

335

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“…In our patient, the thrombosis of left lower limb veins was diagnosed before the initiation of heparin. Fondaparinux is used to anti-coagulate patients with established HIT, as it has no affinity to PF-4 [7]. We have not contemplated to use novel oral anticoagulants, dabigatran (direct thrombin inhibitors), and apixaban and rivaroxaban (factor Xa inhibitors) for these drugs were not approved for patients in stage 5 chronic kidney disease [8].…”

Section: Discussionmentioning

confidence: 99%

Phlegmasia cerulean dolens: complication of femoral vein catheterization

et al. 2016

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There are three less frequent manifestations of acute massive venous thrombosis and obstruction of the venous drainage of an extremity. They are phlegmasia alba dolens, phlegmasia cerulean dolens (PCD), and venous gangrene. The term PCD differentiates ischemia-associated massive venous thrombosis from phlegmasia alba dolens, which describes fulminant venous thrombosis without ischemia. We present a 55-year-old hypertensive, who presented with paedal oedema and breathlessness at rest. About a month prior to this admission, she suffered dislocation of left patella. She was treated with a plaster cast and immobilization for 3 weeks. Her serum creatinine was 8.8 mg/dL. She was initiated on haemodialysis via two single-lumen catheters placed in left femoral vein. The femoral vein catheters were removed after third session of haemodialysis. On fourth day, the patient complained pain and blue discolouration of left toes. On examination, the left lower limb was swollen, discoloured, and cold with blebs up to upper one-third of left leg. The left dorsalis pedis and posterior tibial arteries were not palpable. A Doppler of veins of lower limb revealed, thrombosis of deep, and superficial venous system of left lower limb. As there was no response to anticoagulation below, knee amputation was performed.

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“…It does not interact with heparin-PF4 complexes, and the formation of a sensitizing complex resulting in an HIT is not possible. Many case reports and retrospective reviews have shown that Fondaparinux can be used in the treatment of thrombosis due to HIT (7,8). Recombinant factor VIIa can be used to reverse the anticoagulant effect of fondaparinux in case of severe bleeding with fondaparinux anticoagulation (7,8).…”

Section: öZmentioning

confidence: 99%

“…Many case reports and retrospective reviews have shown that Fondaparinux can be used in the treatment of thrombosis due to HIT (7,8). Recombinant factor VIIa can be used to reverse the anticoagulant effect of fondaparinux in case of severe bleeding with fondaparinux anticoagulation (7,8). Fondaparinux, like lepirudine, is eliminated primarily through the kidneys (and is contraindicated in patients with creatinine clearance <30 ml/min), thus making the issue of appropriate dosing in dialysis patients uncertain (6)(7)(8).…”

Section: öZmentioning

confidence: 99%

“…Recombinant factor VIIa can be used to reverse the anticoagulant effect of fondaparinux in case of severe bleeding with fondaparinux anticoagulation (7,8). Fondaparinux, like lepirudine, is eliminated primarily through the kidneys (and is contraindicated in patients with creatinine clearance <30 ml/min), thus making the issue of appropriate dosing in dialysis patients uncertain (6)(7)(8). There is only one previous case report about its usage in dialysis patients with thrombosis (9).…”

Section: öZmentioning

confidence: 99%

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