title: Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study.
abstract: Essentials Heparin-induced thrombocytopenia (HIT) is a thrombogenic condition that is difficult to treat. We evaluated rivaroxaban as a treatment option in patients with suspected or confirmed HIT. One patient had recurrent thrombosis and 9/10 patients with thrombocytopenia had platelet recovery. Rivaroxaban may be an effective and safe treatment option for HIT.
  
  
  
  Background Rivaroxaban is a direct oral anti-Xa inhibitor that has the potential to greatly simplify treatment of heparin-induced thrombocytopenia (HIT). Objectives To evaluate the efficacy and safety of rivaroxaban in this patient population, we conducted a multicenter, single-arm, prospective cohort study of patients with suspected or confirmed HIT. Patients/Methods Twenty-two consecutive adults with suspected or confirmed HIT received rivaroxaban 15 mg bid until a local HIT assay result was available. Participants with a positive local assay result continued rivaroxaban 15 mg bid until platelet recovery (or until day 21 if they had acute thrombosis at study entry), then stepped down to rivaroxaban 20 mg daily until day 30. Results and Conclusions The primary outcome measure, incidence of new symptomatic, objectively-confirmed venous and arterial thromboembolism at 30 days, occurred in one HIT-positive participant (4.5%; 95% confidence interval [CI], 0-23.5%) and one HIT-positive participant required limb amputation despite platelet recovery. Platelet recovery was achieved in nine out of 10 HIT-positive patients with thrombocytopenia. Rivaroxaban appears to be effective for treating patients with confirmed HIT, although the small number of patients enrolled limits precision.
authors.affiliation: Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Linkins
authors.affiliation: Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada.|Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: T E
authors.initials: TE
authors.lastname: Warkentin
authors.affiliation: Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada.|Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pai
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Shivakumar
authors.affiliation: Department of Surgery and Cardiac Sciences Program, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: R A
authors.initials: RA
authors.lastname: Manji
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: P S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Nazi
authors.affiliation: Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada.|Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Crowther
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001792:Blood Platelets / Q000187:drug effects; D002170:Canada; D015951:Factor Xa / Q000032:analysis; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D000069552:Rivaroxaban / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006493:Heparin; D000069552:Rivaroxaban; D015951:Factor Xa
keywords: arterial thromboembolism; heparin-induced thrombocytopenia; rivaroxaban; thrombocytopenia; venous thromboembolism