Annals of Hematology

, Volume 97, Issue 11, pp 2055–2059 | Cite as

Comparison of argatroban and fondaparinux for the management of patients with isolated heparin-induced thrombocytopenia

  • Fahad A. S. Al-EidanEmail author
  • Saud Alrawkan
  • Huda Alshammary
  • Mark A. Crowther
Original Article


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.


Argatroban Fondaparinux Heparin-induced thrombocytopenia Management 



We would like to extend special acknowledgment to Razan Aleidan for her contributions in the data collection and entry.

Authors’ contributions

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.


  1. 1.
    Al-Eidan FA (2015) Pharmacotherapy of heparin-induced thrombocytopenia: therapeutic options and challenges in the clinical practices. J Vasc Nurs 33:10–20CrossRefGoogle Scholar
  2. 2.
    Linkins LA, Dans AL, Moores LK et al (2012) 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(Suppl):e495S–e530SCrossRefGoogle Scholar
  3. 3.
    Harenberg J, Jörg I, Fenyvesi T (2002) Heparin-induced thrombocytopenia: pathophysiology and new treatment options. Pathophysiol Haemost Thromb 32(5–6):289–294CrossRefGoogle Scholar
  4. 4.
    Li ZQ, Liu W, Park KS, Sachais BS, Arepally GM, Cines DB, Poncz M (2002) Defining a second epitope for heparin-induced thrombocytopenia/thrombosis antibodies using KKO, a murine HIT-like monoclonal antibody. Blood 99(4):1230–1236CrossRefGoogle Scholar
  5. 5.
    Cuker A, Arepally G, Crowther MA, Rice L, Datko F, Hook K, Propert KJ, Kuter DJ, Ortel TL, Konkle BA, Cines DB (2010) The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion. J Thromb Haemost 8(12):2642–2650CrossRefGoogle Scholar
  6. 6.
    Pouplard C, Gueret P, Fouassier M, Ternisien C, Trossaert M, Régina S, Gruel Y (2007) Prospective evaluation of the ‘4Ts’ score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost 5(7):1373–1379CrossRefGoogle Scholar
  7. 7.
    Bauer KA, Hawkins DW, Peters PC, Petitou M, Herbert JM, van Boeckel CA, Meuleman DG (2002) Fondaparinux, a synthetic pentasaccharide: the first in a new class of antithrombotic agents—the selective factor Xa inhibitors. Cardiovasc Drug Rev 20(1):37–52CrossRefGoogle Scholar
  8. 8.
    Cuker A (2014) Clinical and laboratory diagnosis of heparin induced thrombocytopenia: an integrated approach. Semin Thromb Hemost 40:106–114PubMedGoogle Scholar
  9. 9.
    ASSERACHROM® HPIA package insert. (2011) Diagnostica Stago S.A.S, Asniere sur Seine, France. Accessed 8 Jan 2018
  10. 10.
    Ritchie BM, Connors JM, Sylvester KW (2015) Comparison of an IgG-specific enzyme-linked immunosorbent assay cutoff of 0.4 versus 0.8 and 1.0 optical density units for heparin-induced thrombocytopenia. Clin Appl Thromb Hemost. CrossRefGoogle Scholar
  11. 11.
    Brandner J, Hallisey RK, Kuter DJ (2004) Fondaparinux in the treatment of heparin-induced thrombocytopenia. Blood 104(11):abstract 1775Google Scholar
  12. 12.
    Al-Rossaies A, Alkharfy KM, Al-Ayoubi F, Al-Momen A (2011) Heparin-induced thrombocytopenia: comparison between response to fondaparinux and lepirudin. Int J Clin Pharm 33:997–1001CrossRefGoogle Scholar
  13. 13.
    Tardy-Poncet B, Nguyen P, Thiranos JC, Morange PE, Biron-Andréani C, Gruel Y, Morel J, Wynckel A, Grunebaum L, Villacorta-Torres J, Grosjean S, de Maistre E (2015) Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial. Crit Care 19:396CrossRefGoogle Scholar
  14. 14.
    Kang M, Alahmadi M, Sawh S, Kovacs MJ, Lazo-Langner A (2015) Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood 125:924–929CrossRefGoogle Scholar
  15. 15.
    Skrupky LP, Smith JR, Deal EN, Arnold H, Hollands JM, Martinez EJ, Micek ST (2010) Comparison of bivalirudin and argatroban for the management of heparin-induced thrombocytopenia. Pharmacotherapy 30:1229–1238CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Fahad A. S. Al-Eidan
    • 1
    • 2
    Email author
  • Saud Alrawkan
    • 1
  • Huda Alshammary
    • 3
  • Mark A. Crowther
    • 4
  1. 1.College of MedicineKing Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical CityRiyadhSaudi Arabia
  2. 2.King Abdulaziz Medical CityRiyadhSaudi Arabia
  3. 3.Arar Central HospitalArarSaudi Arabia
  4. 4.Department of MedicineMcMaster UniversityHamiltonCanada

Personalised recommendations