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CC BY 4.0 · TH Open 2020; 04(04): e305-e308
DOI: 10.1055/s-0040-1713175
Case Report

Failure of Fondaparinux in Autoimmune Heparin-Induced Thrombocytopenia

Michelangelo Sartori
1   Cardiovascular Department, Angiology and Blood Coagulation Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
,
Benilde Cosmi
1   Cardiovascular Department, Angiology and Blood Coagulation Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Abstract

Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin that is associated with life-threatening thrombotic complications. More rarely, HIT may begin after stopping of heparin or after flushes of heparin (autoimmune HIT). Fondaparinux has been proposed as a candidate treatment for HIT, but there are few data on its use in autoimmune HIT. An 86-year-old man with a history of diabetes mellitus, arterial hypertension, and hypercholesterolemia was admitted to our hospital for carotid endarterectomy. During surgery, only one heparin dose of 5,000 U was used. Platelet count started to decrease on the 11th day after surgery. Since the patient was not receiving heparin treatment/prophylaxis, HIT was not suspected. On day 19, platelet count was 61 × 103/μL, and the patient was investigated for a diagnosis of HIT. Immunoglobulin (Ig)-G-specific enzyme-linked immunosorbent assay (ELISA) was positive and HIT was confirmed by a platelet aggregation test; fondaparinux 5 mg once a day was started. During fondaparinux treatment, platelet count did not increase and a lower leg deep vein thrombosis occurred. Fondaparinux was stopped and rivaroxaban 15 mg twice a day was started. Platelet count returned to base line after 10 days from fondaparinux withdrawal. There was no thrombotic event or bleeding complication during rivaroxaban treatment. Anecdotal evidence suggests risk of failure of fondaparinux treatment for autoimmune HIT and supports the use of rivaroxaban for treatment of HIT, justifying larger studies.

Keywords

heparin-induced thrombocytopenia - rivaroxaban - deep vein thrombosis - fondaparinux

Note

Informed consent was obtained from the patient for the purpose of publication.




Publication History

Received: 19 March 2020

Accepted: 11 May 2020

Article published online:
20 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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