Comparison of argatroban and fondaparinux for the management of patients with isolated heparin-induced thrombocytopenia
Heparin-induced thrombocytopenia (HIT) is a serious complication of the administration of heparin and its derivatives. Non-heparin anticoagulants such as argatroban and fondaparinux are widely used in the management of HIT to compare the effectiveness of argatroban and fondaparinux in the resolution of thrombocytopenia and to compare clinical outcomes in patients with isolated HIT. A retrospective cohort analysis was performed at King Abdulaziz Medical City (KAMC) on patients diagnosed with isolated HIT between 31 Jan, 2014 and 30 June, 2017. Demographics data, non-heparin anticoagulants, related laboratory results, and clinical outcomes were retrieved and analysed. The cohort comprised a total of 95 adult patients who received either argatroban (56 patients) or fondaparinux (39 patients) for isolated HIT. The median age and sex distribution were similar in both argatroban and fondaparinux groups. The mean (+ SD) time (in days) for the resolution of thrombocytopenia was 3.5 (± 1.8) for patients who received argatroban and 3.7 (± 1.7) for patients administered fondaparinux (p = 0.843). Thromboembolic events occurred in five patients (8.9%) administered argatroban and in three patients (7.7%) administered fondaparinux (p = 0.382). There was no significant difference in the rates of bleeding or death (p = 0.829); however, the small number of cases limits our ability to draw conclusions about these outcomes. In this retrospective study, fondaparinux and argatroban were similarly effective in resolving thrombocytopenia, preventing further thromboembolic events, and maintaining safety in patients with confirmed HIT. To confirm this observation, larger prospective studies are needed.
KeywordsArgatroban Fondaparinux Heparin-induced thrombocytopenia Management
We would like to extend special acknowledgment to Razan Aleidan for her contributions in the data collection and entry.
F.A.S. Al-Eidan designed and initiated the study, analysed the data, and drafted the manuscript. S. Alrawkan and H. Alshamari contributed to the collection and interpretation of the data and revised the manuscript. M. Crowther critically revised the manuscript. All authors approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
Professor Mark Crowther discloses having participated in various medicolegal activities relating to thrombosis, anticoagulant drugs, or other aspects of haematological practice, and that these activities are bound by confidentiality arrangements. Dr. Crowther holds the Leo Pharma Chair in Thromboembolism research; the funding for this is held in perpetuity at McMaster University and the interest is used to support Dr. Crowther’s research activities. Other authors have nothing to disclose.
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