Difference between revisions of "Heparin-induced thrombocytopenia"
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==== Anticoagulation ==== | ==== Anticoagulation ==== | ||
− | * '''ALicia:''' Lepirudin paitents 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. | + | * '''ALicia:''' [[Lepirudin (Refludan)]] paitents 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. |
− | * '''ALicia:''' Lepirudin paitents with moderate renal impairment (creatinine >=1.3 mg/dl): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. | + | * '''ALicia:''' [[Lepirudin (Refludan)]] paitents with moderate renal impairment (creatinine >=1.3 mg/dl): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. |
− | * '''ALicia:''' Lepirudin paitents with without renal impairment (creatinine <1.3 mg/dl): 50 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. | + | * '''ALicia:''' [[Lepirudin (Refludan)]] paitents with without renal impairment (creatinine <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 === | === References === | ||
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==== Anticoagulation ==== | ==== Anticoagulation ==== | ||
− | * Rivaroxaban: 15 mg PO BID until platelet recovery (or until day 21 if acute thrombosis present at study entry), then 20mg daily until day 30 | + | * [[Rivaroxaban (Xarelto)]]: 15 mg PO BID until platelet recovery (or until day 21 if acute thrombosis present at study entry), then 20mg daily until day 30 |
=== References === | === References === |
Revision as of 16:35, 11 September 2018
Section editors | |||
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Shruti Chaturvedi, MBBS, MSCI Baltimore, MD |
Benjamin Tillman, MD Nashville, TN |
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Guidelines
To be completed
All lines of therapy
Argatroban monotherapy
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 M et al. 2015 | Retrospective, propensity score-matched | Fondaparinux | Similar efficacy and safety to fondaparinux |
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.
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.anja A Treschan[author],
- 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. PubMed.
- Only 15 patients (23%) in the study had confirmed HIT.
- 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.
Danaparoid monotherapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Kang M et al. 2015 | Retrospective, propensity score-matched | Fondaparinux | Similar efficacy and safety to fondaparinux |
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.
Fondaprinux monotherapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Kang M et al. 2015 | Retrospective, propensity score-matched | Argatroban, Danaparoid | Similar efficacy and safety to argatroban, danaparoid |
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
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Treschan et al. 2014 (ALicia) | Randomized, double-blind | Argatroban | Suggests less bleeding in surgical patients with argatroban. |
Anticoagulation
- ALicia: Lepirudin (Refludan) paitents 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.
- ALicia: Lepirudin (Refludan) paitents with moderate renal impairment (creatinine >=1.3 mg/dl): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- ALicia: Lepirudin (Refludan) paitents with without renal impairment (creatinine <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. PubMed.
- Only 15 patients (23%) in the study had confirmed HIT.
Rivaroxaban monotherapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Linkins et al. 2016 | Prospective cohort | None | New thrombosis in one patient (4.5%) |
Anticoagulation
- Rivaroxaban (Xarelto): 15 mg PO BID 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.