David Green, MD, PhD reviewing Warkentin TE et al. Blood 2017 Jun 23.
A systematic literature review finds DOACs safe and effective for HIT.
Antithrombotic therapy is required to manage heparin-induced thrombocytopenia (HIT), but currently approved agents such as argatroban must be given parenterally and closely monitored. Whether direct oral anticoagulants (DOACs) are sufficiently potent to control HIT-related thrombosis is uncertain.
To address this question, investigators at McMaster University in Canada examined their own experience and conducted a systematic review of the literature regarding the use of DOACs for initial treatment of acute HIT as well as after other primary therapies.
A total of 80 patients received a DOAC for treatment of probable HIT; 67% received rivaroxaban, 17% apixaban, and 16% dabigatran. Rivaroxaban was the primary therapy for 25 of 46 patients; only one of the 46 had progression of thrombosis, and none had major bleeding.
A total of 12 patients received apixaban and 11 received dabigatran, generally after another primary therapy. Of these 23 patients, only one had a thrombotic event and none had major bleeding.
Warkentin TE et al. Direct oral anticoagulants for treatment of HIT: Update of Hamilton experience and literature review. Blood 2017 Jun 23; blood-2017-04-778993; [e-pub].