Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico

O., Gustavo Rivera; S., Oscar Corsi; J., Andrés Pavlovic; S., Andrés Aizman; A., Pablo Varas

doi:10.4067/s0034-98872017000901213

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…DOACs are brief, do not require repeated testing of thrombus and coagulation functions, and do not cross react with PF4/heparin antibodies. In the past 5 years, the applications of DOACs for HIT treatment is gradually increasing, [8][9][10] making it a potential alternative to the conventional therapeutics. Among them, Rivaroxaban is the most available, and it can attenuate further platelet reduction after HIT as well as reduce thrombotic events.…”

Section: Discussionmentioning

confidence: 99%

Advanced lung cancer patient with isolated heparin-induced thrombocytopenia: A case report

Jiang

Han

et al. 2022

Medicine

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Rationale: Heparin-induced thrombocytopenia (HIT), a potentially devastating form of drug-induced thrombocytopenia, occurs in patients receiving heparin for thrombosis prevention or treatment. An isolated HIT is characterized by decreased platelet counts without thrombosis, which are atypical and difficult to clinically find. Symptoms and clinical findings:A 33-year-old female patient's admission examination revealed elevated D-dimer levels. After prophylactic anticoagulation using low-molecular weight heparin, her blood platelet counts were rapidly decreased, whereas her D-dimer levels increased, followed by presentations of chest tightness, abdominal pain, and skin itching without thrombosis. After excluding all the other causes of thrombocytopenia, HIT was suspected. Her 4Ts score was 5 points, and enzyme-linked immunoassay for platelet factor 4 (PF4)/heparin antibodies was positive, indicating isolated HIT. Diagnoses, interventions, and outcomes:The patient was diagnosed with advanced lung cancer presenting with isolated HIT. We immediately stopped low-molecular weight heparin and initiated rivaroxaban for anticoagulation. We administered thrombopoietin (TPO) and avatripopal maleate tablets to increase blood platelet counts, whereas intravenous immunoglobulin (IVIG) was administered to stimulate her immune system. The patient's thrombocytopenia was successfully treated without thrombosis and bleeding complications.Lessons: Rivaroxaban is a potential option for tumor preventive anticoagulation and HIT treatment. Early HIT identification is necessary. After identification, the 4Ts score as well as PF4/heparin antibodies should be assessed and appropriate anticoagulants selected based on patients' conditions.Abbreviations: ACCP = the American College of Clinical Pharmacy, APTT = activated partial thromboplastin time, ASCO = the American Society of Clinical Oncology, ASH = the American Society of Hematology, DOACs = direct oral anticoagulant drugs, ECG = electrocardiogram, ELISA = enzyme-linked immunosorbent assay, HIPA = heparin-induced platelet aggregation assay, HIT = heparin-induced thrombocytopenia, IVIG = intravenous immunoglobulin, LMWH = low-molecular weight heparin, PET/CT = positron emission tomography/computed tomography, PF4 = platelet factor 4, SEOM = the Spanish Society of Clinical Oncology, SRA = serotonin release assay, TPO = thrombopoietin, UFH = unfractionated heparin.

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Section: Discussionmentioning

confidence: 99%

Advanced lung cancer patient with isolated heparin-induced thrombocytopenia: A case report

Jiang

Han

et al. 2022

Medicine

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Potential Role of Direct Oral Anticoagulants in the Management of Heparin‐induced Thrombocytopenia

Barlow

Reinaker

et al. 2019

Pharmacotherapy

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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.

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Enoxaparin sodium

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Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico

Cited by 5 publications

References 15 publications

Advanced lung cancer patient with isolated heparin-induced thrombocytopenia: A case report

Advanced lung cancer patient with isolated heparin-induced thrombocytopenia: A case report

Potential Role of Direct Oral Anticoagulants in the Management of Heparin‐induced Thrombocytopenia

Enoxaparin sodium

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