title: New oral anticoagulants in the treatment of heparin-induced thrombocytopenia.
abstract: BACKGROUND
  Heparin induced thrombocytopenia (HIT) is a potentially catastrophic syndrome with a high incidence of vascular thrombosis. There are little data on the efficacy of new oral anticoagulants (NOAC) in this setting. This study reports on the outcome of patients with HIT, treated with NOAC.
  
  
  METHODS
  We retrospectively identified 22 patients with HIT who were treated by our group with a combination of NOAC and a short course of argatroban. These patients were evaluated in a prospective fashion for development of outcomes at a mean follow up of 19±3 months.
  
  
  RESULTS
  There were a total of 5 deep and 2 superficial vein thromboses diagnosed at index hospitalization. No patient developed arterial thrombosis. All patients tolerated NOAC and their platelet count normalized before discharge. At 19 months of follow-up, 6 patients had died of non-thrombotic causes. There was no bleeding, limb loss or recurrent venous thromboembolism in any patient.
  
  
  CONCLUSIONS
  In patients with HIT, a short course of parenteral treatment with argatroban followed by administration of a NOAC is highly safe and effective in prevention of thrombosis and normalization of platelet count. Development of HIT however, portends a poor prognosis independent of vascular thrombosis.
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, United States; A.T. Still University, Mesa, Arizona, United States. Electronic address: seyedmohsensharifi@yahoo.com.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sharifi
authors.affiliation: A.T. Still University, Mesa, Arizona, United States.
authors.forename: Curt
authors.initials: C
authors.lastname: Bay
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, United States.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Vajo
authors.affiliation: A.T. Still University, Mesa, Arizona, United States.
authors.forename: Wilbur
authors.initials: W
authors.lastname: Freeman
authors.affiliation: Arizona Cardiovascular Consultants & Vein Clinic, United States.
authors.forename: Mirali
authors.initials: M
authors.lastname: Sharifi
authors.affiliation: A.T. Still University, Mesa, Arizona, United States.
authors.forename: Frederic
authors.initials: F
authors.lastname: Schwartz
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Deep venous thrombosis; Heparin- induced thrombocytopenia; New oral anticoagulants