Bivalirudin for the treatment of patients with confirmed or suspected heparin-induced thrombocytopenia.
J Thromb Haemost. 2014 Apr 26;
Authors: Joseph L, Casanegra AI, Dhariwal M, Smith MA, Raju MG, Militello MA, Gomes MP, Gornik HL, Bartholomew JR
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated response to unfractionated heparin and, less commonly, low molecular weight heparin. It is associated with a high thrombotic risk and potential for limb and life-threatening complications. Argatroban is the only approved and currently available anticoagulant for HIT treatment in the US. Objectives: To report safety and efficacy outcomes of bivalirudin for HIT treatment.
METHODS: We retrospectively examined records from our registry of patients with suspected, confirmed or a previous history of HIT and received bivalirudin for anticoagulation in a single tertiary care center over a 9 year period.
RESULTS: We identified 461 patients who received bivalirudin: 220 (47.7%) were surgical and 241 (52.3%) were medical patients. Of this population, 107 (23.2%) were critically ill, and 109 (23.6%) were dialysis-dependent. Suspected, confirmed and a previous history of HIT were reported in 262, 124 and 75 patients respectively. Of 386 patients with suspected or confirmed HIT, 223 patients (57.8%) had thrombosis at HIT diagnosis. New thrombosis was identified in 21 patients (4.6%) while on treatment with therapeutic doses of bivalirudin. No patient required HIT-related amputation. Major bleeding occurred in 35 patients (7.6%). We found a significant increase in major bleeding risk in critically ill population (13.1%; OR 2.4, 95% CI 1.2-4.9, p=0.014). The 30 day all-cause mortality rate was 14.5% (67 patients), and 8 of 67 (1.7%) deaths were HIT-related.
CONCLUSION: Bivalirudin may be an effective and safe alternative option for treatment of both suspected and confirmed HIT, and appears to reduce HIT-related amputation. This article is protected by copyright. All rights reserved.
PMID: 24766902 [PubMed - as supplied by publisher]