Rivaroxaban for treatment of heparin-induced thrombocytopenia after cardiac surgery: A case report

Abouchakra, Laure; Khabbaz, Ziad; Abouassi, Samah; Badaoui, Georges

doi:10.1016/j.jtcvs.2015.04.054

Cited by 21 publications

(10 citation statements)

References 5 publications

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“…167 There are case reports of dabigatran use after left ventricular assist device placement 168 and of rivaroxaban use for heparin induced thrombocytopenia after coronary artery bypass grafting. 169 However, these off-label uses are not supported by available clinical trial evidence.…”

Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

224

147

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Non–vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

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Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

224

147

View full text Add to dashboard Cite

show abstract

“…Therefore, no conclusions can be drawn regarding cardiac surgery‐related events. Further reports of rivaroxaban in cardiovascular surgery include a case report of rivaroxaban usage as an off‐label alternative to the standard treatment for heparin‐induced thrombocytopenia type II , and a case description of a patient on rivaroxaban treatment suffering acute type‐A aortic dissection who received PCC pre‐operatively and had delayed (uncomplicated) surgery .…”

Section: Overview Of Doacs In Cardiac Surgerymentioning

confidence: 99%

International consensus statement on the peri‐operative management of direct oral anticoagulants in cardiac surgery

et al. 2018

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Despite current recommendations on the management of severe peri-operative bleeding, there is no pragmatic guidance for the peri-operative monitoring and management of cardiac surgical patients taking direct oral anticoagulants. Members of the Transfusion and Haemostasis Subcommittee of the European Association of Cardiothoracic Anaesthesiology, of their own volition, performed an independent systematic review of peerreviewed original research, review articles and case reports and developed the following consensus statement. This has been endorsed by the European Association of Cardiothoracic Anaesthesiology. In our opinion, most patients on direct oral anticoagulant therapy presenting for elective cardiac surgery can be safely managed in the peri-operative period if the following conditions are fulfilled: direct oral anticoagulants have been discontinued two days before cardiac surgery, corresponding to five elimination half-live periods; in patients with renal or hepatic impairment or a high risk of bleeding, a pre-operative plasma level of direct oral anticoagulants has been determined and found to be below 30 ng.ml À1 (currently only valid for dabigatran, rivaroxaban and apixaban). In cases where plasma level monitoring is not possible (e.g. assay was not available), discontinuation for 10 elimination half-live periods (four days) is required. For FXa inhibitors, a standard heparin-calibrated anti-Xa level of < 0.1 IU.ml À1 should be measured, indicating sufficient reduction in the anticoagulant effect. Finally, short-term bridging with heparin is not required in the pre-operative period.

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“…In our review, a patient with HIT-related thrombosis of a coronary artery graft experienced resolution of this thrombus (as well as partial regression of a carotid bulb thrombosis) after 1 month of rivaroxaban therapy. 27 In another patient, however, extensive VTE comprising bilateral DVT, bilateral PE, and right atrial thrombus was managed only with a brief period of dabigatran prior to transitioning to warfarin. 31 The optimal duration of therapy with DOAC-based treatment for HIT/HITT is not known.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple case reports provide further evidence to support the role of rivaroxaban in HIT management [26][27][28][29] (Table 2). Sartori et al reported the case of a 68-year-old male with recent orthopedic procedure who came to the ED for suspected lower extremity deep venous thrombosis (DVT).…”

Section: Rivaroxabanmentioning

confidence: 96%

Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

Tran

2017

Clin Appl Thromb Hemost

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Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) are rare but potentially limb- and life-threatening complications of heparin therapy. Continuation of heparin or low-molecular-weight heparin is contraindicated due to platelet activation in the presence of (heparin-dependent) HIT antibodies. Primary treatment options currently include argatroban, fondaparinux, or bivalirudin. However, the parenteral administration routes and interference of argatroban with traditional coagulation markers complicate management. The goal of this review is to assess the viability of direct oral anticoagulants as an alternative treatment option in patients with HIT/HITT. Their use in HIT/HITT is reasonable, given absent cross-reactivity preformed with HIT antibodies. Furthermore, their rapid onset of action and induction of effective anticoagulation provide a favorable basis for their use in this condition. Herein, we summarize 3 studies and 8 case reports comprising 56 patients in whom direct oral anticoagulants were used in the treatment of HIT/HITT.

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Rivaroxaban for treatment of heparin-induced thrombocytopenia after cardiac surgery: A case report

Cited by 21 publications

References 5 publications

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

International consensus statement on the peri‐operative management of direct oral anticoagulants in cardiac surgery

Emerging Role of Direct Oral Anticoagulants in the Management of Heparin-Induced Thrombocytopenia

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