Direct Oral Anticoagulants as Successful Treatment of Heparin-Induced Thrombocytopenia: A Parisian Retrospective Case Series

Frontiers in Medicine

article

Julie Carré¹  Dominique Helley³  Agnès Lillo-Le Louet¹  Nicolas Gendron¹  Leyla Calmette⁶  Hippolyte Guérineau⁶  Christine Le Beller¹  Laëtitia Mauge²  Benoit Huynh⁷  Roya Nili¹  Benjamin Planquette¹  Sylvain Clauser⁶  David M. Smadja¹ 

[1] Université de Paris;Hematology Department, Centre-Université de Paris;Centre de Recherche Cardiovasculaire de Paris;Pharmacovigilance Department, Centre-Université de Paris;Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Centre-Université de Paris;Hematology-Immunology-Transfusion Department, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin;Hematology Department, Institut Mutualiste Montsouris;Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Centre-Université de Paris

关键词: heparin-induced thrombocytopenia;    direct oral anticoagulant;    thrombosis;    platelets;    apixaban;    rivaroxaban;   

DOI  :  10.3389/fmed.2021.713649

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Heparin-induced thrombocytopenia (HIT) is a prothrombotic life-threatening disorder caused by an adverse reaction to heparin exposure. In this context, it is imperative to stop heparin immediately and to replace it by a non-heparin anticoagulant therapy. Despite their advantages, the use of direct oral anticoagulants (DOACs) is only emerging for HIT treatment, and their use remains rare. Objective: To improve our knowledge on the emerging role of DOACs as treatment of HIT and give an overview of our local practices in this context. Patients/Methods: This is a multi-centric retrospective case series of HIT patients referred to our Parisian pharmacovigilance network and treated with DOACs. Results: We report the cases of seven patients from four healthcare centers, diagnosed with HIT (4T score ≥ 4, positive anti-PF4/heparin immunoassay and positive serotonin-release assay) and treated with DOACs. After a few days on substitutive parenteral treatment ( n = 6) or directly at HIT diagnosis ( n = 1), these patients were treated with either rivaroxaban ( n = 6) or apixaban ( n = 1) during acute HIT phase. Mean time to platelet count recovery after heparin discontinuation was 3.3 days (range 3–5). No patient experienced major or clinically relevant non-major bleeding or thrombosis that could be related to DOAC treatment during follow-up. Conclusions: Our cases studies are consistent with recent guidelines credit to the potential and safe use of DOAC during acute HIT in clinically stable patients.

【 授权许可】

CC BY