Tags

Type your tag names separated by a space and hit enter

Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia.
Pharmacotherapy 2019; 39(8):837-853P

Abstract

Heparin-induced thrombocytopenia (HIT) is a rare, potentially life-threatening condition secondary to unfractionated heparin or low molecular weight heparin exposure. This immune-mediated drug reaction manifests as thrombocytopenia with a paradoxical hypercoagulable state that can result in life-threatening thrombosis. It is imperative to ensure cessation of heparin-based products as soon as HIT is identified. Traditional treatment options include argatroban, bivalirudin, fondaparinux, and danaparoid with a transition to warfarin upon platelet recovery. These anticoagulants are notwithstanding limitations including parenteral administration and routine laboratory monitoring leading to prolonged hospitalizations, emphasizing the need for new therapies. Direct oral anticoagulants (DOACs) have been increasingly investigated for the management of HIT and may overcome the aforementioned challenges of current therapies. The objective of this narrative review is to summarize the current HIT guidelines, discuss limitations to contemporary treatment options, provide insight into the emerging evidence for the DOACs rivaroxaban, apixaban, and dabigatran, and conclude with a clinical summary for their use in this setting. The PubMed, Google Scholar, and MEDLINE databases were searched for peer-reviewed literature from January 1, 2012, to June 31, 2018. Twenty-seven articles met inclusion criteria for review: 1 prospective trial, 5 retrospective cohort studies, and 21 case reports totaling 104 patients treated with a DOAC for HIT. The DOACs prevented new and recurrent thrombosis in 98% (n=102) of cases, and bleeding complications occurred in 3% (n=3). While current literature remains limited, it is suggestive of a potential role of DOACs for HIT, which has led to their integration into the 2018 American Society Hematology Guidelines with a conditional recommendation.

Authors+Show Affiliations

Thomas Jefferson College of Pharmacy, Philadelphia, Pennsylvania.Thomas Jefferson College of Pharmacy, Philadelphia, Pennsylvania.Department of Pharmacy, Einstein Medical Center, Philadelphia, Pennsylvania.Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31233222

Citation

Barlow, Ashley, et al. "Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia." Pharmacotherapy, vol. 39, no. 8, 2019, pp. 837-853.
Barlow A, Barlow B, Reinaker T, et al. Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. Pharmacotherapy. 2019;39(8):837-853.
Barlow, A., Barlow, B., Reinaker, T., & Harris, J. (2019). Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. Pharmacotherapy, 39(8), pp. 837-853. doi:10.1002/phar.2298.
Barlow A, et al. Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. Pharmacotherapy. 2019;39(8):837-853. PubMed PMID: 31233222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. AU - Barlow,Ashley, AU - Barlow,Brooke, AU - Reinaker,Travis, AU - Harris,Justin, Y1 - 2019/07/18/ PY - 2019/6/25/pubmed PY - 2019/6/25/medline PY - 2019/6/25/entrez KW - apixaban KW - dabigatran KW - direct oral anticoagulants KW - direct thrombin inhibitors KW - heparin-induced thrombocytopenia KW - rivaroxaban KW - thrombocytopenia KW - thrombosis SP - 837 EP - 853 JF - Pharmacotherapy JO - Pharmacotherapy VL - 39 IS - 8 N2 - Heparin-induced thrombocytopenia (HIT) is a rare, potentially life-threatening condition secondary to unfractionated heparin or low molecular weight heparin exposure. This immune-mediated drug reaction manifests as thrombocytopenia with a paradoxical hypercoagulable state that can result in life-threatening thrombosis. It is imperative to ensure cessation of heparin-based products as soon as HIT is identified. Traditional treatment options include argatroban, bivalirudin, fondaparinux, and danaparoid with a transition to warfarin upon platelet recovery. These anticoagulants are notwithstanding limitations including parenteral administration and routine laboratory monitoring leading to prolonged hospitalizations, emphasizing the need for new therapies. Direct oral anticoagulants (DOACs) have been increasingly investigated for the management of HIT and may overcome the aforementioned challenges of current therapies. The objective of this narrative review is to summarize the current HIT guidelines, discuss limitations to contemporary treatment options, provide insight into the emerging evidence for the DOACs rivaroxaban, apixaban, and dabigatran, and conclude with a clinical summary for their use in this setting. The PubMed, Google Scholar, and MEDLINE databases were searched for peer-reviewed literature from January 1, 2012, to June 31, 2018. Twenty-seven articles met inclusion criteria for review: 1 prospective trial, 5 retrospective cohort studies, and 21 case reports totaling 104 patients treated with a DOAC for HIT. The DOACs prevented new and recurrent thrombosis in 98% (n=102) of cases, and bleeding complications occurred in 3% (n=3). While current literature remains limited, it is suggestive of a potential role of DOACs for HIT, which has led to their integration into the 2018 American Society Hematology Guidelines with a conditional recommendation. SN - 1875-9114 UR - https://www.unboundmedicine.com/medline/citation/31233222/Potential_Role_of_Direct_Oral_Anticoagulants_in_the_Management_of_Heparin-induced_Thrombocytopenia L2 - https://doi.org/10.1002/phar.2298 DB - PRIME DP - Unbound Medicine ER -