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Apixaban: a novel agent to treat heparin induced thrombocytopenia and to prevent embolism in patient with atrial fibrillation after multiple valve replacement?


Very limited but promising experiences with the use of direct factor Xa inhibitors for the treatment of heparin-induced thrombocytopenia (HIT) have been reported. This contribution features our first experience with the use of apixaban (without a pre-treatment with parenteral anticoagulant) to treat a case of HIT which developed in a patient after multiple heart replacement surgery. Apixaban was effective, well tolerated and safe. An apixaban-calibrated chromogenic anti-Xa activity assessment was used to monitor apixaban activity throughout the therapy. Patient continued on apixaban for the prevention of thrombosis in the settings of atrial fibrillation. No ischemic or bleeding events occurred during the clinical follow up and the platelet count was stable. Our experience suggests that apixaban might be effectively used for the treatment of HIT and for the long-term prevention of embolism in patients after multiple valve replacement with biological prostheses and atrial fibrillation.

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This study was supported by APVV Project 16-0020 (Slovak Research and Development Agency). The authors would like to thank Mr. Paul McCullough for proofreading.

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Correspondence to Matej Samoš.

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Conflict of interest

Matej Samoš, Tomáš Bolek, Ingrid Škorňová, Jakub Benko, Ján Staško, Peter Kubisz, Peter Galajda, and MariánMokáň declare that they have no conflicts of interest that might be relevant to the content of this manuscript.


This study was supported by APVV Project 16-0020 (Slovak Research and Development Agency).

Ethical approval and inform consent

This research was conducted according to ethical standards and was approved by the local ethical committee (Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava). The patient agreed to participate in the research and signed the informed consent for participation.

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Samoš, M., Bolek, T., Škorňová, I. et al. Apixaban: a novel agent to treat heparin induced thrombocytopenia and to prevent embolism in patient with atrial fibrillation after multiple valve replacement?. J Thromb Thrombolysis 48, 619–622 (2019). https://doi.org/10.1007/s11239-019-01910-0

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  • Apixaban
  • Heparin-induced thrombocytopenia
  • Heart valve replacement
  • Atrial fibrillation
  • Anti-Xa activity assessment