Literature DB >> 26440400

A case of probable bemiparin-induced heparin-induced thrombocytopenia type II managed with low-dose fondaparinux.

A N Koul1.   

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Year:  2015        PMID: 26440400      PMCID: PMC4943375          DOI: 10.4103/0022-3859.166519

Source DB:  PubMed          Journal:  J Postgrad Med        ISSN: 0022-3859            Impact factor:   1.476


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Sir, I want to make following observations regarding the article, “a case of probable bemiparin-induced heparin-induced thrombocytopenia (HIT) type II managed with low-dose fondaparinux” published in your esteemed journal. The profile of the patient is not completely recorded. Patient in question may have thrombocytopenia due to sepsis or ischemic abdomen with disseminated intravascular coagulation. She has abdominal pain, high lactate dehydrogenase, respiratory alkalosis, and the cause for her pain is not ascertained. As this patient had undergone surgery recently, there could be multiple causes for low platelet count Fondaparinux is not a drug of choice for HIT. It is advisable to use direct thrombin inhibitors like argatroban or bivalirudin. They are Food and Drug Administration (FDA) approved drugs to be used in patients of thrombosis with HIT. Novel anticoagulant drugs such as rivaroxaban, dabigatran, and apixaban are being used as an alternative therapy for HIT but are not FDA approved, nor American College of Chest Physicians recommends them. Fondaparinux is recommended to be used in pregnant patients who develop HIT[12] The authors have replaced fondaparinux with acenocoumarol after some time without overlap therapy. Such a step could have increased the risk of paradoxical thrombosis or skin necrosis in protein C or S deficiency.[2]
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Review 1.  How I treat heparin-induced thrombocytopenia.

Authors:  Adam Cuker; Douglas B Cines
Journal:  Blood       Date:  2012-01-13       Impact factor: 22.113

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1.  Authors' reply.

Authors:  T Koufakis; K Tsapakidis; A Margaritis; I Gabranis
Journal:  J Postgrad Med       Date:  2015 Oct-Dec       Impact factor: 1.476

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