Difference between revisions of "Heparin-induced thrombocytopenia"
Warner-admin (talk | contribs) m (Text replacement - "Category:Heparin-induced thrombocytopenia (HIT) regimens" to "Category:Heparin-induced thrombocytopenia regimens") |
(Update of Rivaroxaban for HIT - added more recent reference.) Tag: visualeditor |
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− | !colspan="4 | + | ! colspan="4" style="color:white; font-size:125%; background-color:#31a354" align="center" |'''Section editors''' |
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− | |style="background-color:#F0F0F0; width:15%"|[[File:Shruti.jpg|frameless|upright=0.3|center]] | + | | style="background-color:#F0F0F0; width:15%" |[[File:Shruti.jpg|frameless|upright=0.3|center]] |
− | |style="width:35%"|<big>[[User:Shrutichaturvedi|Shruti Chaturvedi, MBBS, MSCI]]<br>Johns Hopkins University<br>Baltimore, MD</big><br>[https://www.linkedin.com/in/shruti-chaturvedi-bb83b126/ LinkedIn] | + | | style="width:35%" |<big>[[User:Shrutichaturvedi|Shruti Chaturvedi, MBBS, MSCI]]<br>Johns Hopkins University<br>Baltimore, MD</big><br>[https://www.linkedin.com/in/shruti-chaturvedi-bb83b126/ LinkedIn] |
− | |style="background-color:#F0F0F0; width:15%"|[[File:Tillman_Benjamin-2.jpg|frameless|upright=0.3|center]] | + | | style="background-color:#F0F0F0; width:15%" |[[File:Tillman_Benjamin-2.jpg|frameless|upright=0.3|center]] |
− | |style="width:35%"|<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Vanderbilt University<br>Nashville, TN</big> | + | | style="width:35%" |<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Vanderbilt University<br>Nashville, TN</big> |
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=== References === | === References === | ||
# Linkins LA, Warkentin TE, Pai M, Shivakumar S, Manji RA, Wells PS, Wu C, Nazi I, Crowther MA. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study. J Thromb Haemost. 2016 Jun;14(6):1206-10. [https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.13330 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27061271 PubMed] | # Linkins LA, Warkentin TE, Pai M, Shivakumar S, Manji RA, Wells PS, Wu C, Nazi I, Crowther MA. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study. J Thromb Haemost. 2016 Jun;14(6):1206-10. [https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.13330 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27061271 PubMed] | ||
+ | ## UPDATE: Warkentin TE, Pai M, Linkins LA. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017; 130:1104-1113. [http://www.bloodjournal.org/content/130/9/1104.long?sso-checked=true link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28646118 PubMed] | ||
[[Category:Heparin-induced thrombocytopenia regimens]] | [[Category:Heparin-induced thrombocytopenia regimens]] |
Revision as of 22:28, 12 March 2019
Section editors | |||
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Shruti Chaturvedi, MBBS, MSCI Johns Hopkins University Baltimore, MD |
Benjamin Tillman, MD Vanderbilt University Nashville, TN |
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Guidelines
ASH
- 2018: Cuker et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
All lines of therapy
Argatroban monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Lewis et al. 2001 (ARG-911) | Prospective, historical control | Multiple | Reduced all-cause death, all-cause amputation, and new thrombosis |
Lewis et al. 2003 (ARG-915) | Prospective, historical control | Multiple | Reduced all-cause death, all-cause amputation, or new thrombosis |
Treschan et al. 2014 (ALicia) | Randomized, double-blind | Lepirudin | Suggests less bleeding in surgical patients with argatroban. |
Kang et al. 2015 | Retrospective, propensity score-matched | Fondaparinux | Similar efficacy and safety to fondaparinux |
Tardy-Poncet et al. 2015 | Prospective | None | New or extended thrombosis in 25% of patients and major bleeding in 15%. |
Note: In ALicia, only 15 patients (23%) in the study had confirmed HIT.
Note: In the study by Tardy-Poncet et al. only 20 patients were enrolled, 16 with confirmed by as judged by an independent scientific committee. The majority (14, 70%) were in an intensive care unit, and six patients died due to their underlying medical condition.
Anticoagulation
- ARG-911, ARG-915: Argatroban (Acova) 2 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 3.0 times baseline value.
- ALicia: Argatroban (Acova) without liver dysfunction: 0.5 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- ALicia: Argatroban (Acova) with severe liver dysfunction (bilirubin >4 mg/dL): 0.25 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- Tardy-Poncet: Starting dose of 1 mcg/kg/min IV but those with hepatic impairment or at risk of decreased hepatic perfusion were recommended to start at 0.5 mcg/kg/min. Child-Pugh Class C patients were excluded.
References
- ARG-911: 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; ARG-911 Study Investigators. Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia. Circulation. 2001 Apr 10;103(14):1838-43. link to original article PubMed
- ARG-915: Lewis BE, Wallis DE, Leya F, Hursting MJ, Kelton JG; ARG-915 Study Investigators. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia. Arch Intern Med. 2003;164:1849-1856. link to original article PubMed
- ALicia: Treschan TA, Schaefer MS, Geib J, Bahlmann A, Brezina T, Werner P, Golla E, Greinacher A, Pannen B, Kindgen-Milles D, Kienbaum P, Beiderlinden M. Argatroban versus lepirudin in critically ill patients (ALicia): a randomized controlled trial. Critical Care. 2014 Oct 25;18(5):588. link to original article link to PMC article PubMed
- Kang M, Alahmadi M, Sawh S, Kovacs MJ, Lazo-Langner A. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood. 2015 Feb 5;125(6):924-9. link to original article PubMed
- Tardy-Poncet B, Nguyen P, Thiranos JC, Morange PE, Biron-Andreani C, Gruel Y, Morel J, Wynckel A, Grunebaum L, Villacorta-Torres J, Grosjean S, de Maistre E. Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial. Crit Care. 2015 Nov 11;19:396. link to original article PubMed
Danaparoid monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Chong et al. 2001 | Phase III | Dextran 70 | Improved complete clinical recovery with danaparoid |
Kang et al. 2015 | Retrospective, propensity score-matched | Fondaparinux | Similar efficacy and safety to fondaparinux |
Anticoagulation
- Danaparoid (Orgaran) 2400 anti-Xa units IV bolus once, then 400 units per hour for 2h, 300 units per hour for 2h, and then 200 units per hour for five days.
References
- Chong BH, Gallus AS, Cade JF, Magnani H, Manoharan A, Oldmeadow M, Arthur C, Rickard K, Gallo J, Lloyd J, Seshadri P, Chesterman CN; Australian HIT Study Group. Prospective randomised open-label comparison of danaparoid with dextran 70 in the treatment of heparin-induced thrombocytopaenia with thrombosis: a clinical outcome study. Thromb Haemost. 2001 Nov;86(5):1170-5. link to original article PubMed
- Kang M, Alahmadi M, Sawh S, Kovacs MJ, Lazo-Langner A. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood. 2015 Feb 5;125(6):924-9. link to original article PubMed
Fondaparinux monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Kang et al. 2015 | Retrospective, propensity score-matched | 1. Argatroban 2. Danaparoid |
Similar efficacy and safety to argatroban, danaparoid |
To be completed
Anticoagulation
References
- Kang M, Alahmadi M, Sawh S, Kovacs MJ, Lazo-Langner A. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood. 2015 Feb 5;125(6):924-9. link to original article PubMed
Lepirudin monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Treschan et al. 2014 (ALicia) | Randomized, double-blind | Argatroban | Suggests less bleeding in surgical patients with argatroban. |
Note: Only 15 patients (23%) in the study had confirmed HIT.
Anticoagulation
- Lepirudin (Refludan) as follows:
- Patients with continuous renal replacement therapy: 5 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- Patients with moderate renal impairment (creatinine 1.3 mg/dl or more): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- Patients with without renal impairment (creatinine less than 1.3 mg/dl): 50 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
References
- ALicia: Treschan TA, Schaefer MS, Geib J, Bahlmann A, Brezina T, Werner P, Golla E, Greinacher A, Pannen B, Kindgen-Milles D, Kienbaum P, Beiderlinden M. Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial. Critical Care. 2014 Oct 25;18(5):588. link to original article link to PMC article PubMed
Rivaroxaban monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Linkins et al. 2016 | Prospective cohort | None | New thrombosis in one of the HIT patients (8.3%) |
Note: In the first prospective study of DOACs in HIT by Linkins, 22 patients were enrolled with suspected HIT. The overall symptomatic recurrent VTE rate was 4.5% (1 patient out of 22), but only 12 of the patients were confirmed to have HIT. The thrombotic event rate among HIT-positive participants was 8.3%. The study was stopped early due to slow accrual but had enrolled the minimum required number of HIT patients.
Anticoagulation
- Rivaroxaban (Xarelto): 15 mg PO twice per day until platelet recovery (or until day 21 if acute thrombosis present at study entry), then 20mg daily until day 30
References
- Linkins LA, Warkentin TE, Pai M, Shivakumar S, Manji RA, Wells PS, Wu C, Nazi I, Crowther MA. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study. J Thromb Haemost. 2016 Jun;14(6):1206-10. link to original article PubMed
- UPDATE: Warkentin TE, Pai M, Linkins LA. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017; 130:1104-1113. link to original article PubMed