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Heparin-induced thrombocytopenia treated with fondaparinux: single centre experience.
Int Angiol 2019IA

Abstract

BACKGROUND

Heparin-induced thrombocytopenia (HIT) is the most frequent drug- induced, immune-mediated thrombocytopenia. It is associated with significant morbidity and mortality. Anticoagulation with heparin must be stopped immediately and replaced by some suggested alternative - lepirudin, danaparoid or argatroban. Fondaparinux has been also successfully used in HIT.

METHODS

We present a cohort of 10 patients diagnosed with HIT and treated in a university hospital in a period of four years. Diagnosis was based on Keeling ́s scoring system, screening imunologic test for HIT (STic EXPERT® HIT) and sandwich ELISA (detection of IgG/ heparin-PF4 antibodies). While other alternative anticoagulants are not readily available in our hospital, we used fondaparinux in all cases.

RESULTS

From 2014 to 2018, eight males and two females (mean age 67 years, range 46-86 years) were diagnosed with HIT in our hospital. This complication developed in 9 cases after low-molecular-weight heparin and in one after heparin flushes in hemodialysis. A drop in platelet count developed in all patients, thrombotic complications in 7 and skin necrosis in 2 cases. Fondaparinux was used in all patients, including two cases with severe renal impairment, the dose was chosen individually. We observed complete platelet recovery in all cases. One patient died because of advanced malignancy, others did not have any complication. In 6 cases we switched to oral anticoagulation after platelet recovery.

CONCLUSIONS

In our group of 10 HIT patients fondaparinux was shown to be both safe and effective, even in those with severe renal impairment. Additional studies are warranted to confirm this observation.

Authors+Show Affiliations

4th Department of Internal Medicine and Hematology, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic.4th Department of Internal Medicine and Hematology, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic.4th Department of Internal Medicine and Hematology, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic.4th Department of Internal Medicine and Hematology, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic.4th Department of Internal Medicine and Hematology, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic.2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic - hirmerova@fnplzen.cz. Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31782283

Citation

Dulicek, Petr, et al. "Heparin-induced Thrombocytopenia Treated With Fondaparinux: Single Centre Experience." International Angiology : a Journal of the International Union of Angiology, 2019.
Dulicek P, Ivanova E, Kostal M, et al. Heparin-induced thrombocytopenia treated with fondaparinux: single centre experience. Int Angiol. 2019.
Dulicek, P., Ivanova, E., Kostal, M., Fiedlerova, Z., Sadilek, P., & Hirmerova, J. (2019). Heparin-induced thrombocytopenia treated with fondaparinux: single centre experience. International Angiology : a Journal of the International Union of Angiology, doi:10.23736/S0392-9590.19.04247-0.
Dulicek P, et al. Heparin-induced Thrombocytopenia Treated With Fondaparinux: Single Centre Experience. Int Angiol. 2019 Nov 25; PubMed PMID: 31782283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heparin-induced thrombocytopenia treated with fondaparinux: single centre experience. AU - Dulicek,Petr, AU - Ivanova,Eva, AU - Kostal,Milan, AU - Fiedlerova,Zuzana, AU - Sadilek,Petr, AU - Hirmerova,Jana, Y1 - 2019/11/25/ PY - 2019/11/30/entrez PY - 2019/11/30/pubmed PY - 2019/11/30/medline JF - International angiology : a journal of the International Union of Angiology JO - Int Angiol N2 - BACKGROUND: Heparin-induced thrombocytopenia (HIT) is the most frequent drug- induced, immune-mediated thrombocytopenia. It is associated with significant morbidity and mortality. Anticoagulation with heparin must be stopped immediately and replaced by some suggested alternative - lepirudin, danaparoid or argatroban. Fondaparinux has been also successfully used in HIT. METHODS: We present a cohort of 10 patients diagnosed with HIT and treated in a university hospital in a period of four years. Diagnosis was based on Keeling ́s scoring system, screening imunologic test for HIT (STic EXPERT® HIT) and sandwich ELISA (detection of IgG/ heparin-PF4 antibodies). While other alternative anticoagulants are not readily available in our hospital, we used fondaparinux in all cases. RESULTS: From 2014 to 2018, eight males and two females (mean age 67 years, range 46-86 years) were diagnosed with HIT in our hospital. This complication developed in 9 cases after low-molecular-weight heparin and in one after heparin flushes in hemodialysis. A drop in platelet count developed in all patients, thrombotic complications in 7 and skin necrosis in 2 cases. Fondaparinux was used in all patients, including two cases with severe renal impairment, the dose was chosen individually. We observed complete platelet recovery in all cases. One patient died because of advanced malignancy, others did not have any complication. In 6 cases we switched to oral anticoagulation after platelet recovery. CONCLUSIONS: In our group of 10 HIT patients fondaparinux was shown to be both safe and effective, even in those with severe renal impairment. Additional studies are warranted to confirm this observation. SN - 1827-1839 UR - https://www.unboundmedicine.com/medline/citation/31782283/Heparin-induced_thrombocytopenia_treated_with_fondaparinux:_single_centre_experience L2 - https://www.minervamedica.it/index2.t?show=R34Y9999N00A19112507 DB - PRIME DP - Unbound Medicine ER -