Heparin induced thrombocytopenia

E. A. Sanidas; N. A. Viniou; P. Diamantopoulos; J. Barbetseas

doi:10.5482/HAMO-15-04-0013

Hämostaseologie, Table of Contents

Hamostaseologie 2015; 35(04): 372-375
DOI: 10.5482/HAMO-15-04-0013

Review

Schattauer GmbH

Heparin induced thrombocytopenia

Contemporary therapeutic approaches in light of the new oral anticoagulantsHeparin-induzierte ThrombopenieZeitgemäße Therapien unter Berücksichtigung neuer Antikoagulanzien

E. A. Sanidas

¹Department of Cardiology, Laiko General Hospital, Athens, Greece

,

N. A. Viniou

²Hematology Unit, 1st Dept. of Internal Medicine, University of Athens, Laiko General Hospital, Athens, Greece

,

P. Diamantopoulos

²Hematology Unit, 1st Dept. of Internal Medicine, University of Athens, Laiko General Hospital, Athens, Greece

,

J. Barbetseas

¹Department of Cardiology, Laiko General Hospital, Athens, Greece

› Author Affiliations

Abstract

Summary

Heparin induced thrombocytopenia (HIT) is a prothrombotic syndrome initiated by platelet-activating auto-antibodies with potentially devastating complications. Once the diagnosis of HIT is suspected, discontinuation of heparin and treatment with an alternative anticoagulant are mandatory. While established drugs for HIT are no longer available, parenteral factor Xa inhibitors, thrombin inhibitors and perhaps the direct oral anticoagulants provide additional treatment options. The aim of this review was to highlight the current clinical aspects regarding HIT focusing on the role of novel medications.

Zusammenfassung

Die Heparin-induzierte Thrombopenie (HIT) ist eine prothrombotische Erkrankung, die durch thrombozytenaktivierende Autoantikörper hervorgerufen wird und fatale Komplikationen auslösen kann. Bei Verdacht auf eine HIT muss Heparin abgesetzt und ein anderes Antikoagulanz gegeben werden. Es gibt zwar keine ausdrücklichen Arzneimittel gegen HIT mehr, aber parenteral verabreichte Faktor-Xa-Inhibitoren, Thrombinhemmer und möglicherweise direkte orale Antikoagulanzien können weitere Therapieoptionen sein. Diese Übersicht soll die aktuellen klinischen Aspekte von HIT mit Schwerpunkt auf der Rolle der neuen Arzneimittel darlegen.

Keywords

HIT - DOAC

Schlüsselwörter

HIT - DOAC

Full Text

References

References
1 Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood 2005; 106: 2710-2715.
2 Warkentin TE, Levine MN, Hirsh J. et al. Heparininduced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-1335.
3 Rauova L, Zhai L, Kowalska MA. et al. Role of platelet surface PF4 antigenic complexes in heparininduced thrombocytopenia pathogenesis: diagnostic and therapeutic implications. Blood 2006; 107: 2346-2353.
4 Lee GM, Arepally GM. Diagnosis and management of heparin-induced thrombocytopenia. Hematol Oncol Clin North Am 2013; 27: 541-563.
5 Almeida JI, Coats R, Liem TK, Silver D. Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome. J Vasc Sur 1998; 27: 309-314.
6 Warkentin TE, Sheppard JA, Sigouin CS. et al. Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia. Blood 2006; 108: 2937-2941.
7 Prandoni P, Siragusa S, Girolami B. et al. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecularweight heparin: a prospective cohort study. Blood 2005; 106: 3049-3054.
8 Linkins LA, Dans AL, Moores LK. et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e495S-530S.
9 Warkentin TE, Greinacher A, Koster A, Lincoff AM. American College of Chest P. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence Based Clinical Practice Guidelines (8th ed). Chest 2008; 133: 340S-380S.
10 Baglin TP. Heparin induced thrombocytopenia thrombosis (HIT/T) syndrome: diagnosis and treatment. J Clin Pathol 2001; 54: 272-274.
11 Pouplard C, Gueret P, Fouassier M. et al. Prospective evaluation of the ‘4Ts’ score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost 2007; 05: 1373-1379.
12 Cuker A, Arepally G, Crowther MA. et al. The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion. J Thromb Haemost 2010; 08: 2642-2650.
13 Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med 1996; 101: 502-507.
14 Warkentin TE, Davidson BL, Buller HR. et al. Prevalence and risk of preexisting heparin-induced thrombocytopenia antibodies in patients with acute VTE. Chest 2011; 140: 366-373.
15 Goldfarb MJ, Blostein MD. Fondaparinux in acute heparin-induced thrombocytopenia: a case series. J Thromb Haemost 2011; 09: 2501-2503.
16 Warkentin TE, Sheppard JA, Manheim JC. HIT complicating fondaparinux prophylaxis: fondaparinux-dependent platelet activation as a marker for fondaparinux-induced HIT. Thromb Haemost 2014; 112: 1319-1322.
17 Nazi I, Arnold DM, Moore JC. et al. Pitfalls in the diagnosis of heparin-Induced thrombocytopenia: A 6-year experience from a reference laboratory. Am J Hematol 2015; 90: 629-633.
18 Koster A, Dyke CM, Aldea G. et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Ann Thoracic Surg 2007; 83: 572-577.
19 Stone GW, Witzenbichler B, Guagliumi G. et al. Bivalirudin during primary PCI in acute myocardial infarction. The N Engl J Med 2008; 358: 2218-2230.
20 Joseph L, Casanegra AI, Dhariwal M. et al. Bivalirudin for the treatment of patients with confirmed or suspected heparin-induced thrombocytopenia. J Thromb Haemost 2014; 12: 1044-1053.
21 Walenga JM, Drenth AF, Mayuga M. et al. Transition from argatroban to oral anticoagulation with phenprocoumon or acenocoumarol: effect on coagulation factor testing. Clin Appl Thromb Hemost 2008; 14: 325-331.
22 Kodityal S, Nguyen PH, Kodityal A. et al. Argatroban for suspected heparin-induced thrombocytopenia: contemporary experience at a large teaching hospital. J Inten Care Med 2006; 21: 86-92.
23 Lewis BE, Wallis DE, Berkowitz SD. et al. Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia. Circulation 2001; 103: 1838-1843.
24 Swan SK, Hursting MJ. The pharmacokinetics and pharmacodynamics of argatroban: effects of age, gender, and hepatic or renal dysfunction. Pharmacotherapy 2000; 20: 318-329.
25 Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 311S-337S.
26 Lubenow N, Eichler P, Lietz T. et al. Lepirudin in patients with heparin-induced thrombocytopenia – results of the third prospective study (HAT-3) and a combined analysis of HAT-1, HAT-2, and HAT-3. J Thromb Haemost 2005; 03: 2428-2436.
27 Farner B, Eichler P, Kroll H, Greinacher A. A comparison of danaparoid and lepirudin in heparininduced thrombocytopenia. Thromb Haemost 2001; 85: 950-957.
28 Rocio JJJ-NHinojar, Covadonga FernandezGolfın, Jose ZamoranoLuis. New oral anticoagulants: a practical guide for physicians. Eur Heart J Cardiovasc Pharmacother 2015; 01: 134-145.
29 Hankey GJ, Eikelboom JW. Dabigatran etexilate: a new oral thrombin inhibitor. Circulation 2011; 123: 1436-1450.
30 Eriksson BI, Dahl OE, Rosencher N. et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 2007; 370: 949-956.
31 Granger CB, Alexander JH, McMurray JJ. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981-992.
32 Walenga JM, Prechel M, Hoppensteadt D. et al. Apixaban as an alternate oral anticoagulant for the management of patients with heparin-induced thrombocytopenia. Clin Appl Thromb Hemost 2013; 19: 482-487.
33 EINSTEIN Investigators. Bauersachs R, Berkowitz SD. et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010; 363: 2499-2510.
34 EINSTEIN-PE Investigators. Buller HR, Prins MH. et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012; 366: 1287-1297.
35 Walenga JM, Prechel M, Jeske WP. et al. Rivaroxaban--an oral, direct Factor Xa inhibitor--has potential for the management of patients with heparin-induced thrombocytopenia. Br J Haematol 2008; 143: 92-99.
36 Ng HJ, Than H, Teo EC. First experiences with the use of rivaroxaban in the treatment of heparin-induced thrombocytopenia. Thromb Res 2015; 135: 205-207.