Anti–platelet factor 4–heparin antibodies present a major risk of heparin-induced thrombocytopenia (HIT). The use of intravenous immune. A new Clinical Practice article provides an overview of heparin induced thrombocytopenia. HIT is characterized by a platelet count fall of more. Correspondence from The New England Journal of Medicine — Heparin-Induced Thrombocytopenia Associated with Fondaparinux.
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Antithrombotic therapy is required to manage heparin-induced thrombocytopenia HITbut currently approved agents such as argatroban must be given parenterally and closely monitored.
To address this question, investigators at McMaster University in Canada examined their own experience and conducted a systematic review of the literature regarding the use of DOACs for initial treatment of acute HIT as well as after other primary therapies. Rivaroxaban was the primary therapy for 25 of 46 patients; only one of the 46 had progression of thrombosis, and none had major bleeding. A total of 12 patients received apixaban and 11 received dabigatran, generally after another primary therapy.
CLINICAL PRACTICE. Heparin-Induced Thrombocytopenia.
Of these 23 patients, only one had a thrombotic event and none had major bleeding. Because observational studies such as those reported here might be biased by patient selection, randomized trials that compare DOACs with either argatroban or fondaparinux are urgently needed.
For the present, clinicians might consider prescribing a DOAC for acute HIT and tailoring the dose and duration of treatment for each patient. Warkentin TE et al. Direct oral anticoagulants for treatment of HIT: Update of Hamilton experience and literature inudced. Blood Jun 23; blood; [e-pub]. J Clin Oncol Dec 7.
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