title: Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study.
abstract: Current guidelines for heparin-induced thrombocytopenia (HIT) management recommend heparin cessation and switching to a nonheparin anticoagulant (ie, argatroban, danaparoid) upon clinical suspicion. Fondaparinux may be effective but information supporting its use is limited. We retrospectively evaluated 239 patients who received a nonheparin anticoagulant (fondaparinux = 133, danaparoid = 59, and argatroban = 47) for suspected or confirmed HIT. A propensity score was constructed based on age, gender, creatinine, 4T scores, and comorbidity index, and used to match 133 patients to 60 controls. Outcomes were thrombosis or thrombosis-related death and major bleeding. In the matched population there were 22 (16.5%) episodes of thromboses in the fondaparinux group and 13 (21.4%) in the control group (χ(2) P = .424). Bleeding was observed in 28 (21.1%) patients in the fondaparinux group compared with 12 (20%) in the control group (χ(2) P = .867). Survival analysis, and subgroup and unmatched analyses showed similar results. In the fondaparinux group, 60% of patients received prophylactic doses. Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists.
authors.affiliation: Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada;
authors.forename: Matthew
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada;
authors.forename: Majed
authors.initials: M
authors.lastname: Alahmadi
authors.affiliation: Pharmacy Services, London Health Sciences Centre, London, ON, Canada; and.
authors.forename: Sonja
authors.initials: S
authors.lastname: Sawh
authors.affiliation: Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kovacs
authors.affiliation: Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
authors.forename: Alejandro
authors.identifier: http://orcid.org/0000-0001-6869-8431
authors.initials: A
authors.lastname: Lazo-Langner
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux