Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia.
Pharmacotherapy. 2019 Jun 24;:
Authors: Barlow A, Barlow B, Reinaker T, Harris J
Heparin-induced thrombocytopenia (HIT) is a rare, potentially life-threatening condition secondary to unfractionated heparin or low molecular weight heparin exposure. This immune-mediated drug reaction manifests as thrombocytopenia with a paradoxical hypercoagulable state that can result in life-threatening thrombosis. It is imperative to ensure cessation of heparin-based products as soon as HIT is identified. Traditional treatment options include argatroban, bivalirudin, fondaparinux, and danaparoid with a transition to warfarin upon platelet recovery. These anticoagulants are notwithstanding limitations including parenteral administration and routine lab monitoring leading to prolonged hospitalizations emphasizing the need for new therapies. Direct oral anticoagulants (DOACs) have been increasingly investigated for the management of HIT and may overcome the aforementioned challenges of current therapies. The objective of this narrative review is to summarize the current HIT guidelines, limitations to contemporary treatment options, provide insight on the emerging evidence for the DOACs rivaroxaban, apixaban, and dabigatran, and a clinical summary for their use in this setting. The PubMed, Google Scholar, and Medline databases were searched for peer-reviewed literature from January 1, 2012 to June 31, 2018. Twenty-seven articles met inclusion criteria for review: 1 prospective trial, 5 retrospective cohort studies, and 21 case reports totaling 104 patients treated with a DOAC for HIT. The DOACs prevented new and recurrent thrombosis in 98% (n=102) of cases and bleeding complications occurred in 3% (n=3). While current literature remains limited, it is suggestive of a potential role of DOACs for HIT, which has led to their integration into the 2018 American Society Hematology Guidelines with a conditional recommendation. This article is protected by copyright. All rights reserved.
PMID: 31233222 [PubMed - as supplied by publisher]