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Rivaroxaban in the Treatment of Heparin-Induced Thrombocytopenia

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Abstract

Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition and it is associated with increased in vivo thrombin generation that needs to be treated with non-heparin anticoagulants such as direct thrombin inhibitors (DTIs). DTIs require parenteral administration and are associated with a non negligible risk of major bleeding. We describe a case of HIT treated with rivaroxaban, a direct oral factor Xa inhibitor which could be used to inhibit the generation of thrombin, instead of DTIs. A 68 year-old man with a thrombosis confined to the internal gastrocnemius and soleal veins developed HIT during enoxaparin 80 mg twice a day. Enoxaparin was stopped and rivaroxaban 20 mg once a day was started. Platelet count returned to base line after 6 days from enoxaparin withdrawal. After 3 months rivaroxaban was stopped and the patient had an uneventful course. This case report supports the hypothesis that rivaroxaban may be candidate for treatment of HIT, and larger studies are justified.

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References

  1. Linkins LA, Warkentin TE, Pai M, Shivakumar S, Manji RA, Wells PS, Crowther MA (2014) Design of the rivaroxaban for heparin-induced thrombocytopenia study. J Thromb Thrombolysis 38:485–492

    Article  CAS  PubMed  Google Scholar 

  2. Ng HJ, Than H, Teo EC (2015) First experiences with the use of rivaroxaban in the treatment of heparin-induced thrombocytopenia. Thromb Res 135:205–207

    Article  CAS  PubMed  Google Scholar 

  3. Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, Crowther M (2012) American College of Chest Physicians. 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 141(2 Suppl):e495S–e530S

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Investigators EINSTEIN, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, Lensing AW, Misselwitz F, Prins MH, Raskob GE, Segers A, Verhamme P, Wells P, Agnelli G, Bounameaux H, Cohen A, Davidson BL, Piovella F, Schellong S (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510

    Article  Google Scholar 

  5. Sharifi M, Bay C, Vajo Z, Freeman W, Sharifi M, Schwartz F (2015) New Oral Anticoagulants in the Treatment of Heparin- Induced Thrombocytopenia. Thromb Res 135:607–609

    Article  CAS  PubMed  Google Scholar 

  6. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A (2006) Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin induced thrombocytopenia in two clinical settings. J Thromb Haemost 4:759–765

    Article  CAS  PubMed  Google Scholar 

  7. Legnani C, Cini M, Pili C, Boggian O, Frascaro M, Palareti G (2010) Evaluation of a new automated panel of assays for the detection of anti-PF4/heparin antibodies in patients suspected of having heparin-induced thrombocytopenia. Thromb Haemost 104:402–409

    Article  CAS  PubMed  Google Scholar 

  8. Greinacher A (2009) Heparin-induced thrombocytopenia. J Thromb Haemost 7(Suppl. 1):9–12

    Article  CAS  PubMed  Google Scholar 

  9. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, Baanstra D, Schnee J, Goldhaber SZ, RE-COVER Study Group (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352

    Article  CAS  PubMed  Google Scholar 

  10. Krauel K, Hackbarth C, Fürll B, Greinacher A (2012) Heparin-induced thrombocytopenia: in vitro studies on the interaction of dabigatran, rivaroxaban, and low-sulfated heparin, with platelet factor 4 and anti-PF4/heparin antibodies. Blood 119:1248–1255

    Article  CAS  PubMed  Google Scholar 

  11. Chong BH, Gallus AS, Cade JF, Magnani H, Manoharan A, Oldmeadow M, Arthur C, Rickard K, Gallo J, Lloyd J, Seshadri P, Chesterman CN, Australian HIT Study Group (2001) Prospective randomised open-label comparison of danaparoid with dextran 70 in the treatment of heparin-induced thrombocytopenia with thrombosis: a clinical outcome study. Thromb Haemost 86:1170–1175

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Pad. 2, Via Albertoni, 15, 40138, Bologna, Italy

    Michelangelo Sartori, Elisabetta Favaretto, Michela Cini, Cristina Legnani & Benilde Cosmi

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  1. Michelangelo Sartori
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  2. Elisabetta Favaretto
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  3. Michela Cini
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  4. Cristina Legnani
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  5. Benilde Cosmi
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Correspondence to Michelangelo Sartori.

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Sartori, M., Favaretto, E., Cini, M. et al. Rivaroxaban in the Treatment of Heparin-Induced Thrombocytopenia. J Thromb Thrombolysis 40, 392–394 (2015). https://doi.org/10.1007/s11239-015-1208-4

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  • DOI: https://doi.org/10.1007/s11239-015-1208-4

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