Heparin-induced thrombocytopenia treated with fondaparinux: single center experience
Research article published in International angiology (2019)
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 immunologic 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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Heparin-induced thrombocytopenia treated with fondaparinux: single center experience.
Why This Matters for Hirudotherapy
This single-center cohort study described 10 patients (8 male, 2 female; mean age 67) diagnosed with heparin-induced thrombocytopenia (HIT) between 2014–2018 and treated with fondaparinux, reporting complete platelet recovery in all cases and concluding fondaparinux was safe and effective, including in two patients with severe renal impairment. For ASH and hirudotherapy, the study is relevant because the abstract explicitly cites lepirudin — a recombinant derivative of hirudin from medicinal leech saliva — as a standard alternative anticoagulant for HIT, situating this work within the broader clinical landscape of hirudin-based therapies and their alternatives. Understanding how different anticoagulants perform in HIT informs decision-making around when leech-derived direct thrombin inhibitors may be used or substituted. However, this was a small, uncontrolled observational series at one institution with no comparator arm, so the findings are hypothesis-generating rather than definitive evidence regarding fondaparinux relative to lepirudin or other agents.
Citation
Heparin-induced thrombocytopenia treated with fondaparinux: single center experience
Dulicek P et al. · International angiology, 2019
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