Fondaparinux used for severe heparin induced thrombocytopenia with subacute instent thrombosis

Heparin induced thrombocytopenia (HIT) is an immune mediated event that may result in life and limb threatening complications. We report a 52 year old diabetic woman with subacute instent thrombosis and severe heparin induced thrombocytopenia treated successfully with fondaparinux. Not only platelet count returned to normal but also thromboembolic or hemorrhagic events were prevented under treatment. The low rate of de novo antibody formation and the scarce cross-reactivity with HIT antibodies offer fondaparinux as a relatively safe alternative anticoagulant agent for use in patients with HIT. Fondaparinux should be kept in mind in severe HIT if direct thrombin inhibitors are unavailable.

___

1. Ahmed I, Majeed A and Powell R. Heparin induced thrombocytopenia: diagnosis and management update Postgrad. Med J 2007;83: 575–82.

2. Efird LE, Kockler DE. Fondaparinux for Thromboembolic Treatment and Prophylaxis of Heparin-Induced Thrombocytopenia. Ann Pharmacother 2006;40: 1383-7.

3. Klein HG, Bell WR. Disseminated intravascular coagulation during heparin therapy. Ann Intern Med 974;80:477–81.

4. Keeling DM, Richards EM, Baglin TP. Platelet aggregation in response to four low molecular weight heparins and the heparinoid ORG 10172 in patients with heparin-induced thrombocytopenia. Br J Haematol 1994; 86: 425–6.

5. Package insert. Argatroban (argatroban). Research Triangle Park, NC: GlaxoSmithKline, April 2005.

6. Package insert. Refludan (lepirudin). Montville, NJ: Berlex, October 2004.

7. Package insert. Angiomax (bivalirudin). Parsippany, NJ: The Medicines Company, December 2005.

8. Hassell K. The management of patients with heparin-induced thrombocytopenia who require anticoagulant therapy. Chest 2005;127: 1S-8S.

9. Mulot A, Moulin F, Fohlen-Walter A, Angioi M, Sghaier M, Carteaux JP, et al. Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment. Am J Hematol 2004;77: 67-71.

10. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparininduced thrombocytopenia in two clinical settings. J Thromb Haemost 2006;4: 759–65.

11. Boshkov LK, Warkentin TE, Hayward CP, Andrew M, Kelton JG. Heparin-induced thrombocytopenia and thrombosis: clinical and laboratory studies. Br J Haematol 1993;84: 322–8.

12. Bussey H, Francis JL. Heparin Consensus Group. Heparin overview and issues. Pharmacotherapy 2004;24:103S-107S.

13. Warkentin TE, Maurer BT, Aster RH. Heparin-induced thrombocytopenia associated with fondaparinux. N Engl J Med 2007;356: 2653–5.

14. Warkentin T.E. Fondaparinux versus direct thrombin inhibitor therapy for the management of heparin-induced thrombocytopenia (HIT)- Bridging the River Coumarin editorial Thromb Haemost 2008;99: 2–3.

15. Pouplard C, Couvret C, Regina S, Gruel Y. Development of antibodies specific to polyanion-modified platelet factor 4 during treatment with fondaparinux. J Thromb Haemost 2005;3: 2813–5.

16. Greinacher A, Gopinadhan M, Gunther JU, Omer-Adam MA, Strobel U, Warkentin TE, et al. Close approximation of two platelet factor 4 tetramers by charge neutralization forms the antigens recognized by HIT antibodies. Arterioscler Thromb Vasc Biol 2006;26: 2386–93.

17. Savi P, Chong BH, Greinacher A, Gruel Y, Kelton JG, Warkentin TE, et al. Effect of fondaparinux on platelet activation in the presence of heparin-dependent antibodies: a blinded comparative multicenter study with unfractionated heparin Blood 2005;105: 139-144.
Yeni Tıp Dergisi-Cover
  • ISSN: 1300-2317
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2018
  • Yayıncı: -
Sayıdaki Diğer Makaleler

Alcohol use in Turkish university students and relationship of automobile races

Emin METE, Mehtap ERKMEN, Ahmet KARADAĞ, Nükhet BAVBEK, Ferhat ÇATAL, Cüneyt TAYMAN, Nurdan URAS, Uğur DİLMEN

Evaluating the depression and related factors among the students of the Faculty of Education at Celal Bayar University

HALUK MERGEN, Erdoğmuş Berna MERGEN, Şeref TAN, KURTULUŞ ÖNGEL

Prematüre retinopatisinde green lazertedavi sonuçlarımız

Ayzın Deniz SERTÖZ, SADULLAH KELEŞ, Orhan ATEŞ, İlknur Akyol SALMAN, Orhan BAYKAL, Ayhan TAŞTEKİN, İBRAHİM CANER

Does hormone replacement therapy affect the endometrial pathologies in postmenopausal women?

İlknur İnegöl GÜMÜŞ, Elif KILIÇ, Nilgün Öztürk TURHAN

Halitozis

Abdullah Barış AKCAN, Ayşen Bingöl BOZ, Seyhan Erişir OYGUCU, Murat TURHAN, Oktay DİNÇ

Lumbosakral bölgede yabancı cisim, pediatrik spinal iğne: Radyolojik bulgular

Atilla ARSLANOĞLU, Bayram ÇIRAK

Normal ventrikül fonksiyonları ile giden pulmoner arterden kaynaklanan sol koroner arter anomalili (ALCAPA) bir olgunun tanı koydurucu ekokardiyografik bulguları

Meki BİLİCİ, Utku Arman ÖRÜN, Burhan ÖCAL, Filiz ŞENOCAK

Anaphylactic reaction to diphtheria tetanus vaccine in a young woman

Behçet AL, Cuma YILDIRIM

Multifokal atriyal taşikardi: Bir olgu

Mehmet KARACAN, Haşim OLGUN, Naci CEVİZ

Radikal nefrektomi yapılmış lokal veya lokal ileri renal tümörlerde patolojik nekroz ve sarkomatoid varyant birlikteliğinin önemi: Retrospektif değerlendirme

Emre HURİ, Ali AYYILDIZ, Turgay AKGÜL, M. Özgür YÜCEL, Hüseyin ÜSTÜN, Cankon GERMİYANOĞLU