title: Fondaparinux cross-reacts with heparin antibodies in vitro in a patient with fondaparinux-related thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) related to fondaparinux has been rarely reported, although the ability of fondaparinux to cross-react with heparin antibodies has been often a subject of debate. A patient previously exposed to unfractionated heparin and low-molecular-weight heparin (LMWH) was diagnosed with HIT. During treatment with fondaparinux for 5 consecutive days, his thrombocytopenia significantly deteriorated. A functional platelet activation test in vitro showed clear platelet activation after serum exposure with fondaparinux. After discontinuation of fondaparinux, the platelet count was rapidly reestablished. Fondaparinux cross-reacted with heparin antibodies in this case of HIT, resulting in a deterioration of thrombocytopenia. The implication of this drug in HIT was observed clinically and demonstrated in vitro using a platelet activation test.
authors.affiliation: Department of Internal Medicine I, Division of Cardiology and Intensive Care Medicine, University of Jena, Erlanger Allee 101, Jena, Germany. rudin.pistulli@med.uni-jena.de
authors.forename: Rudin
authors.initials: R
authors.lastname: Pistulli
authors.forename: Volker
authors.initials: V
authors.lastname: Oberle
authors.forename: Hans-Reiner
authors.initials: HR
authors.lastname: Figulla
authors.forename: Atilla
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Pfeifer
mesh_terms: D000906:Antibodies / Q000276:immunology*; D000925:Anticoagulants / Q000009:adverse effects / Q000276:immunology*; D003429:Cross Reactions; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects / Q000276:immunology*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000009:adverse effects / Q000276:immunology*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology
chemical_list: D000906:Antibodies; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux