New Oral Anticoagulants in the Treatment of Heparin- Induced Thrombocytopenia

Pharmacology of Heparin and Related Drugs

“…However, there are also reports that fondaparinux can, in rare cases, cause problems in this setting (Warkentin, 2010;Warkentin et al, 2007Warkentin et al, , 2014Bhatt et al, 2013). Looking forward, it seems likely that use of the orally active direct FIIa and FXa inhibitors (NOACs) will become the established treatment approach in patients with HIT, because reports of their successful use in this context exist (Hantson et al, 2015;Sharifi et al, 2015). Indeed, whether NOACs will eclipse heparins (and indeed vitamin K agonists; Rollins et al, 2014) in the long term for at least some of the established indications of heparins discussed here (Gómez-Outes et al, 2012Neumann et al, 2012;Yoshida et al, 2013;Lazo-Langner et al, 2014), especially if agents for their specific or at least more effective reversal become available (Greinacher et al, 2015), remains to be seen.…”

Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review

“…17,28-51 However, 9 patients 30,48-51 were excluded because they did not seem to have a probable diagnosis of HIT; 5 patients tested negative for anti-PF4/ heparin antibodies 30,40 ; 1 patient had subclinical anti-PF4/heparin antibody seroconversion (as acknowledged by the authors) 48 ; 1 patient had onset of thrombocytopenia too early to be a result of HIT (and testing for HIT antibodies was not performed) 49 ; and 2 other patients had insufficient information available to conclude that HIT was the probable diagnosis. 50,51 The remaining 64 patients were included in our analysis.…”

“…on April 8, 2019. by guest www.bloodjournal.org From For all but 1 article (which described 20 patients with antibodypositive HIT), 30 the patients were presented individually, allowing evaluation of whether HIT was likely present or not. However, in the report describing 20 patients (each of whom had either a positive EIA or a positive SRA) for whom the data were presented in aggregate fashion, all 20 patients received secondary treatment with a DOAC but after receiving a mean of only 32 hours of argatroban; moreover, the mean platelet count at initiation of DOAC therapy was approximately 90 3 10 9 /L (Mohsen Sharifi, personal communication) and thus we classified the 20 patients as group B.…”

Heparin-induced thrombocytopenia: research and clinical updates

“…Rivaroxaban use in HIT has been reported in a small number of case reports, 1 case series, 51 and a multicenter single arm prospective study. 52 The latter prospective single arm study closed early due to poor enrollment, 52 but reported outcomes on 22 enrolled patients, 12 of whom were diagnosed with HIT.…”

“…51 Other than the case series reported by Sharifi et al, 51 there are only case reports on the use of apixaban and dabigatran for HIT (Table 2). [51][52][53] Based on the difficulties encountered by Canadian investigators of the multicenter study of rivaroxaban for HIT, 52 it is unlikely that DOACs will undergo rigorous or systematic investigation in HIT. For now, there is insufficient clinical data or experience to recommend the use of these drugs as stand-alone therapy for HIT.…”