Emerging therapy options in heparin-induced thrombocytopenia
Review published in Cardiovascular & Hematological Agents in Medicinal Chemistry (2014)
Abstract
Heparin-induced thrombocytopenia (HIT) is a life and limb-threatening thrombotic complication of heparin, which is the result of platelet activation by anti-PF4/heparin antibodies. With lepirudin and danaparoid no longer available in the US, treatment options are limited to argatroban, fondaparinux (off-label use) and bivalirudin (for patients undergoing percutaneous coronary intervention). Both argatroban and bivalirudin are parenteral drugs and require close monitoring and hospitalization. Fondaparinux is contraindicated in patients with significant renal impairment and is associated with a small risk of HIT. Anticoagulants approved for thromboprophylaxis and management of thromboembolic conditions such as rivaroxaban, dabigatran, and apixaban have fixed oral dose, rapid onset of action and does not require monitoring. These novel agents do not interact with anti-PF4/heparin antibody and offer attractive therapy options for HIT. Their utility in HIT has been supported by a few clinical reports, however, larger studies are needed before they can be utilized in clinical practice. Therapeutic plasma exchange has been utilized with some success in patients with HIT, who need heparin reexposure for cardiac surgery but their safety and efficacy needs further exploration. 2-O, 3-O desulfated heparin, which lacks any anticoagulant effect, has been shown to reduce the development of HIT in murine models. Finally, novel targets based on the molecular pathogenesis of HIT are being studied for therapeutic drug development. We hope that the availability of novel therapies in the future will expand the options available for the management of HIT.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Reviews HIT pharmacotherapy in the US post-lepirudin/danaparoid withdrawal era — argatroban, fondaparinux, bivalirudin remain — and discusses prospects for oral direct factor Xa and IIa inhibitors and 2-O, 3-O desulfated heparin.
Por qué esto importa para la hirudoterapia
Esta revisión examina las opciones de tratamiento emergentes para la HIT, señalando que la lepirudina y el danaparoide ya no están disponibles en los Estados Unidos, y discute el argatrobán, el fondaparinux, la bivalirudina, los anticoagulantes orales, el recambio plasmático terapéutico y las dianas en investigación. El resumen menciona la lepirudina únicamente como una opción previa que ya no está disponible; no afirma que la lepirudina sea derivada de la sanguijuela, hirudina recombinante, ni que esté relacionada con la saliva de la sanguijuela, y no aborda la hirudoterapia. Por lo tanto, cualquier relevancia directa con el dominio de ASH no se sustenta en el resumen, más allá de la mención histórica de un fármaco llamado lepirudina. La principal limitación es que el artículo es una revisión de alternativas farmacológicas, no un estudio sobre sanguijuelas, componentes del secretoma de la sanguijuela, ni terapia con sanguijuelas vivas.
Citación
Emerging therapy options in heparin-induced thrombocytopenia.
Chaudhary RK et al. · Cardiovascular & Hematological Agents in Medicinal Chemistry, 2014
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026