Design of the rivaroxaban for heparin-induced thrombocytopenia study
- 987 Downloads
Rivaroxaban is an ideal potential candidate for treatment of heparin-induced thrombocytopenia (HIT) because it is administered orally by fixed dosing, requires no laboratory monitoring and is effective in the treatment of venous and arterial thromboembolism in other settings. The Rivaroxaban for HIT study is a prospective, multicentre, single-arm, cohort study evaluating the incidence of new symptomatic venous and arterial thromboembolism in patients with suspected or confirmed HIT who are treated with rivaroxaban. Methodological challenges faced in the design of this study include heterogeneity of the patient population, differences in the baseline risk of thrombosis and bleeding dependent on whether HIT is confirmed or just suspected, and heterogeneity in laboratory confirmation of HIT. The rationale for how these challenges were addressed and the final design of the Rivaroxaban for HIT study is reviewed.
KeywordsHeparin-induced thrombocytopenia Rivaroxaban Study design Clinical trial
Conflict of interest
All authors have contributed to the drafting of this manuscript. The Rivaroxaban for HIT Study is funded by an investigator-initiated study Grant from Bayer Inc. In the past 5 years, Dr. Linkins has received honoraria for presentations from Pfizer. Dr. Warkentin has received lecture honoraria from Pfizer Canada and Instrumentation Laboratories, has provided consulting services to, and/or has received research funding from, GlaxoSmithKline, W. L. Gore, Immucor GTI Diagnostics, and Paringenix, and has provided expert witness testimony relating to HIT. In the last 5 years, Dr. Wells has received honoraria for presentations from Bayer Healthcare, Boehringer Ingelheim, Pfizer and Biomerieiux. He is the recipient of an investigator-initiated research Grant from Bristol Myers Squibb/Pfizer. Dr. Shivakumar has received lecture honoraria from Bayer Inc. Dr. Crowther discloses having sat on advisory boards for Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, Portola, Viropharm and AKP America; provided expert testimony for Bayer and Merck and has received research funding from Boehringer Ingelheim, Octapharm, Pfizer and Leo Pharma. Dr. Manji and Dr. Pai have no conflict of interest with this study.
- 10.Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, Chlumsky J, Verhamme P, Wells P, Agnelli G, Cohen A, Berkowitz SD, Bounameaux H, Davidson BL, Misselwitz F, Gallus AS, Raskob GE, Schellong S, Segers A (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297PubMedCrossRefGoogle Scholar
- 12.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 363:2499–2510PubMedCrossRefGoogle Scholar
- 13.Mega JL, Braunwald E, Wiviott SD, Bassand JP, Bhatt DL, Bode C, Burton P, Cohen M, Cook-Bruns N, Fox KA, Goto S, Murphy SA, Plotnikov AN, Schneider D, Sun X, Verheugt FW, Gibson CM (2012) Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med 366:9–19PubMedCrossRefGoogle Scholar
- 19.Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, Crowther M (2012) Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis: American College of Chest physicians evidence-based clinical practice guidelines. Chest 141:e495S–e530SPubMedCrossRefPubMedCentralGoogle Scholar
- 34.Lewis BE, Wallis DE, Berkowitz SD, Matthai WH, Fareed J, Walenga JM, Bartholomew J, Sham R, Lerner RG, Zeigler ZR, Rustagi PK, Jang IK, Rifkin SD, Moran J, Hursting MJ, Kelton JG (2001) Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia. Circulation 103:1838–1843PubMedCrossRefGoogle Scholar
- 39.Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Nguyen H, Olsson CG, Turpie AG, Weisslinger N (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in medical patients with Enoxaparin Study Group. N Engl J Med 341:793–800PubMedCrossRefGoogle Scholar
- 40.Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, Turpie AG, Egberts JF, Lensing AW (2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 332:325–329PubMedCrossRefPubMedCentralGoogle Scholar