Fondaparinux as a safe alternative for managing heparin-induced thrombocytopenia in postoperative cardiac surgery patients.
OBJECTIVE
Heparin-induced thrombocytopenia (HIT) is a rare but severe prothrombotic disorder of heparin treatment that leads to a decline in platelet count and thrombotic complications. If HIT is suspected, then heparin should be stopped and an alternative anticoagulant started. Fondaparinux is a factor Xa-inhibitor that is not FDA-approved for this condition, but preliminary experience in HIT patients has been reported in the literature. The present study describes an experience of anticoagulation management with fondaparinux in postoperative cardiac surgery patients.


METHODS
Retrospective study.


METHODS
Tertiary hospital.


METHODS
Patients who had undergone cardiac surgery from October 2009 to June 2012.


METHODS
After HIT was suspected clinically, PaGIA and ELISA test were performed in all patients to diagnose HIT. In the patients included, anticoagulation was managed with a low dose of fondaparinux and daily monitoring of platelet count and anti-Xa level.


RESULTS
Of a total of 1,338 postoperative cardiac surgery patients, 15 patients were included (1.1%). Twelve of the 15 patients with HIT presented with renal failure and were under continuous renal replacement therapy. Two major bleeding events occurred during fondaparinux treatment, although platelet count and anti-Xa activity remained within the normal range. No thrombotic episodes were diagnosed.


CONCLUSIONS
With daily monitoring of anti-Xa activity, fondaparinux appeared to be a good alternative to heparin in the study group; however, randomized clinical trials are needed to establish the safety and efficacy of this drug in critically ill, previously HIT patients.
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery. Electronic address: vcegarra@santpau.cat.
Virginia
V
Cegarra-Sanmartín
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery.
Raúl
R
González-Rodríguez
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery.
Pilar
P
Paniagua-Iglesias
Thrombosis and Haemostasis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Amparo
A
Santamaría-Ortiz
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery.
Luisa F
LF
Cueva
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery.
Josefa
J
Galán-Serrano
Service of Anesthesiology, Post Operative Care Unit of Cardiac Surgery.
M Victoria
MV
Moral-García
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001777:Blood Coagulation / Q000187:drug effects*; D006348:Cardiac Surgical Procedures; D004305:Dose-Response Relationship, Drug; D005170:Factor X; D005260:Female; D005500:Follow-Up Studies; D000077425:Fondaparinux; D006331:Heart Diseases / Q000601:surgery; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011134:Polysaccharides / Q000008:administration & dosage*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D005170:Factor X; D000077425:Fondaparinux
HIT; HITT; cardiac surgery; fondaparinux; heparin-induced thrombocytopenia