Heparin induced thrombocytopenia and re-thrombosis associated with warfarin and fondaparinux in a child.
An 11-year-old female developed heparin induced thrombocytopenia (HIT) with thrombosis during therapy for lower extremity deep vein thrombosis and pulmonary embolism. Transition from bivalirudin, a direct thrombin inhibitor (DTI), to warfarin resulted in extensive re-thrombosis, and fondaparinux therapy similarly failed. She was then treated with argatroban, and transitioned successfully to warfarin after 9 weeks. The risk of re-thrombosis was ultimately reduced by allowing time for the thrombogenic potential to abate. The argatroban/warfarin transition was monitored with chromogenic factor X levels. This case highlights several difficult problems in pediatric thrombosis.
Maurer
Scott H
SH
Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. scott.maurer@stjude.org
Wilimas
Judith A
JA
Wang
Winfred C
WC
Reiss
Ulrike M
UM
D000925:Anticoagulants / Q000009:adverse effects*; D002648:Child; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D011134:Polysaccharides / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced*; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D011134:Polysaccharides; D014859:Warfarin; D006493:Heparin; D000077425:Fondaparinux