title: Rivaroxaban for arterial thrombosis related to heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) may be a critical condition in intensive care patients. Diagnosis of HIT is often difficult, and management too, as physicians have usually a limited experience with alternative anticoagulants. A 36-year-old man was admitted for orthopaedic surgery after a trauma causing a fracture of the sacrum and right ankle. Anticoagulant prophylaxis was made by nadroparin (3800  IU/day). But the patient developed less than 10 days after nadroparin exposure a significant drop in platelet count. The diagnosis of HIT was based on the pretest clinical score and demonstration of platelet factor 4 and heparin antibodies. Fondaparinux was transiently administered but was replaced 3 days later by rivaroxaban (15  mg twice a day during 21 days then 20  mg/day), after the demonstration of an acute thrombosis of the left radial artery. Platelet count returned to normal range and a partial recanalization of arterial thrombosis was noted. The use of rivaroxaban in this indication is of theoretical interest but requires further experience.
authors.affiliation: aDepartment of Intensive Care bDivision of Hematology, Université catholique de Louvain, Cliniques St-Luc, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hantson
authors.forename: Catherine
authors.initials: C
authors.lastname: Lambert
authors.forename: Cédric
authors.initials: C
authors.lastname: Hermans
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced*; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D006493:Heparin; D000069552:Rivaroxaban