Fondaparinux for Management of Heparin-Induced Thrombocytopenia

Nov 21, 2017
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Authors:
Schindewolf M, Steindl J, Beyer-Westendorf JB, et al.
Citation:
Use of Fondaparinux Off-Label or Approved Anticoagulants for Management of Heparin-Induced Thrombocytopenia. J Am Coll Cardiol 2017;70:2636-2648.
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

How safe and effective are different anticoagulants, including fondaparinux, for treatment of heparin-induced thrombocytopenia (HIT)?

Methods:

Using a national, multicenter registry study design, hospitalized patients who were diagnosed with HIT (4T scores ≥4 points) and treated with ≥1 dose of approved anticoagulants (argatroban, lepirudin, danaparoid) or fondaparinux were investigated. The main outcome was the incidence of HIT-specific complications (thromboembolic events, amputations, recurrent/persistent thrombocytopenia, skin lesions) and bleeding.

Results:

Of 195 patients included, 46 (23.6%) were treated with argatroban, 4 (2.1%) with lepirudin, 61 (31.3%) with danaparoid, and 84 (43.1%) with fondaparinux. The composite endpoint of HIT-specific complications occurred in 11.7% of patients treated with approved anticoagulants and 0.0% of patients with fondaparinux treatment. All-cause in-hospital mortality occurred in 14.4% of patients treated with approved anticoagulants and 0.0% of patients during fondaparinux treatment. Bleeding occurred in 6.3% of patients treated with approved anticoagulants and 4.8% of patients treated with fondaparinux.

Conclusions:

The authors concluded that fondaparinux is effective and safe in suspected acute HIT.

Perspective:

For patients with HIT, it is critical to initiate nonheparin anticoagulation in order to prevent both thrombotic and bleeding complications. Use of fondaparinux, a selective factor Xa inhibitor, is common for treatment of HIT, albeit without Food and Drug Administration approval. While these data are small in number, and limited by the retrospective design, they provide reassurance that fondaparinux may be a safe and convenient treatment for HIT. Further prospective evaluation would be useful.

Keywords: Amputation, Anticoagulants, Hemorrhage, Factor Xa Inhibitors, Heparin, Hospital Mortality, Primary Prevention, Thrombocytopenia, Vascular Diseases


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