Is Fondaparinux an Effective Alternative Anticoagulant in Patients With Heparin-Induced Thrombocytopenia Type II? A Case Report and Review of the Literature

Abstract

Although rare, heparin-induced thrombocytopenia (HIT) is one of the most feared complications of heparin therapy. It is an antibody-mediated, acquired and transient thrombotic disorder following exposure to heparin. Unfractionated heparin is the standard anticoagulation used in hemodialysis sessions and hemodialysis patients who are continually exposed to heparin are at increased risk for HIT. We report a 75-year-old male patient with acute-on-chronic renal failure who subsequently developed HIT while on hemodialysis. The patient was presented with deep vein thrombosis and successfully treated with fondaparinux. In this report we also review the off-label use of fondaparinux for the treatment and prophylaxis of thrombosis in patients with HIT. As fondaparinux is too small to be recognized by the majority of heparin-reactive antibodies it could be a reasonable alternative anticoagulant for symptomatic HIT patients where licensed drugs like lepirudin and danaparoid are not available. Turkish Başlık: Fondaparinuks Heparinin İndüklediği Trombositopeni Hastalarında Etkili Bir Alternatif Antikoagülan Mıdır? Olgu Sunumu ve Literatür Derlemesi Anahtar Kelimeler: Heparine bağlı trombositopeni, tromboz, hemodiyaliz, fondaparinuks Heparine bağlı trombositopeni (HIT) nadir olmasına karşın heparin tedavisinin en çok korkulan komplikasyonlarından biridir. Heparine bağlı trombositopeni heparin ile temas sonrası oluşan, antikor aracılı edinsel ve geçici bir trombotik bozukluktur. Fraksiyone olmayan heparin hemodiyaliz sırasında kullanılan standart antikoagülandır ve heparin ile sürekli temas eden hemodiyaliz hastalarında HIT riski artmıştır. Burada kronik zeminde akut böbrek yetersizliği olan ve hemodiyaliz sonrasında HIT gelişen 75 yaşında bir erkek hastayı bildiriyoruz. Hastada derin ven trombozu saptandı ve fondaparinuks ile başarıyla tedavi edildi. Bu yazımızda ayrıca HIT hastalarında gelişen trombozun profilaksi ve tedavisinde fondaparinuksun endikasyon dışı kullanımını derledik. Fondaparinuks heparin ile reaksiyon veren antikorların çoğunluğunca tanınmayacak kadar küçük olduğundan lepirudin ve danaparoid gibi lisanslı ilaçların bulunmadığı durumlarda, semptomatik HIT hastaları için mantıklı bir alternatif antikoagülan olabilir.

Keywords

• Heparin-induced thrombocytopenia, thrombosis, hemodialysis, fondaparinux

Fondaparinuks Heparinin İndüklediği Trombositopeni Hastalarında Etkili Bir Alternatif Antikoagülan Mıdır? Olgu Sunumu ve Literatür Derlemesi

Öz

Heparine bağlı trombositopeni (HIT) nadir olmasına karşın heparin tedavisinin en çok korkulan komplikasyonlarından biridir. Heparine bağlı trombositopeni heparin ile temas sonrası oluşan, antikor aracılı edinsel ve geçici bir trombotik bozukluktur. Fraksiyone olmayan heparin hemodiyaliz sırasında kullanılan standart antikoagülandır ve heparin ile sürekli temas eden hemodiyaliz hastalarında HIT riski artmıştır. Burada kronik zeminde akut böbrek yetersizliği olan ve hemodiyaliz sonrasında HIT gelişen 75 yaşında bir erkek hastayı bildiriyoruz. Hastada derin ven trombozu saptandı ve fondaparinuks ile başarıyla tedavi edildi. Bu yazımızda ayrıca HIT hastalarında gelişen trombozun profilaksi ve tedavisinde fondaparinuksun endikasyon dışı kullanımını derledik. Fondaparinuks heparin ile reaksiyon veren antikorların çoğunluğunca tanınmayacak kadar küçük olduğundan lepirudin ve danaparoid gibi lisanslı ilaçların bulunmadığı durumlarda, semptomatik HIT hastaları için mantıklı bir alternatif antikoagülan olabilir.

Anahtar Kelimeler

• Heparine bağlı trombositopeni, tromboz, hemodiyaliz, fondaparinuks

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