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Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia

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Abstract

The development of heparin-induced thrombocytopenia (HIT) is an antibody-mediated clinicopathologic syndrome. The resultant thrombocytopenia and thrombosis can be severe and life-threatening. Fondaparinux is a parenteral factor Xa inhibitor used for venous thromboembolism prevention and treatment. Fondaparinux has minimal affinity for platelet factor 4, making it an alternative agent to unfractionated heparin (UFH) and low-molecular weight heparin (LMWH) and a plausible consideration for patients with a history of HIT. The use of fondaparinux in patients with mechanical heart valve replacement and a history of HIT has never been discussed in the literature. We report on the case of a patient with a mechanical aortic heart valve replacement and a history of HIT who was successfully bridged postoperatively with fondaparinux. While there is currently no literature to support the use of fondaparinux in patients with mechanical heart valves, this drug may offer an option for management of such patients who cannot use heparin products. However, further clinical investigations are warranted to confirm both the safety and efficacy of this agent in the mechanical heart valve population.

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Authors and Affiliations

  1. Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center, 6071 W. Outer Drive, Detroit, MI, 48235, USA

    Tia L. Corbett & Kathy S. Elher

  2. Department of Pharmacy Practice, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, 259 Mack Avenue, Suite 2190, Detroit, MI, 48201, USA

    Candice L. Garwood

  3. Department of Pharmacy, Harper University Hospital, Detroit Medical Center, 3990 John R, Detroit, MI, 48201, USA

    Candice L. Garwood

Authors
  1. Tia L. Corbett
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  2. Kathy S. Elher
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  3. Candice L. Garwood
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Correspondence to Tia L. Corbett.

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Corbett, T.L., Elher, K.S. & Garwood, C.L. Successful use of fondaparinux in a patient with a mechanical heart valve replacement and a history of heparin-induced thrombocytopenia. J Thromb Thrombolysis 30, 375–377 (2010). https://doi.org/10.1007/s11239-010-0494-0

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  • DOI: https://doi.org/10.1007/s11239-010-0494-0

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