Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study.
Blood. 2014 Dec 16;
Authors: Kang M, Alahmadi M, Sawh S, Kovacs MJ, Lazo-Langner A
Current guidelines for heparin-induced thrombocytopenia (HIT) management recommend heparin cessation and switching to a non-heparin anticoagulant (i.e. argatroban, danaparoid) upon clinical suspicion. Fondaparinux may be effective but information supporting its use is limited. We retrospectively evaluated 239 patients who received a non-heparin anticoagulant (133 fondaparinux, 59 danaparoid, 47 argatroban) for suspected or confirmed HIT. A propensity score was constructed based on age, gender, creatinine, 4T scores and comorbidity index and used to match 133 patients to 60 controls. Outcomes were thrombosis or thrombosis-related death and major bleeding. In the matched population there were 22(16.5%) episodes of thromboses in the fondaparinux group and 13(21.4%) in the control group (χ(2) p=0.424). Bleeding was observed in 28(21.1%) patients in the fondaparinux group compared to 12(20%) in the control group (χ(2) p=0.867). Survival analysis and subgroup and unmatched analyses showed similar results. In the fondaparinux group 60% of patients received prophylactic doses. Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists.
PMID: 25515959 [PubMed - as supplied by publisher]