Details

Autor(en) / Beteiligte

• Cegarra-Sanmartín, Virginia, DESA, MD
• González-Rodríguez, Raúl, MD
• Paniagua-Iglesias, Pilar, MD
• Santamaría-Ortiz, Amparo, MD, PhD
• Cueva, Luisa F
• Galán-Serrano, Josefa, MD
• Victoria Moral-García, M., MD

Titel

Fondaparinux as a Safe Alternative for Managing Heparin-Induced Thrombocytopenia in Postoperative Cardiac Surgery Patients

Ist Teil von

• Journal of cardiothoracic and vascular anesthesia, 2014-08, Vol.28 (4), p.1008-1012

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective Heparin-induced thrombocytopenia (HIT) is a rare but severe prothrombotic disorder of heparin treatment that leads to a decline in platelet count and thrombotic complications. If HIT is suspected, then heparin should be stopped and an alternative anticoagulant started. Fondaparinux is a factor Xa-inhibitor that is not FDA-approved for this condition, but preliminary experience in HIT patients has been reported in the literature. The present study describes an experience of anticoagulation management with fondaparinux in postoperative cardiac surgery patients. Design Retrospective study. Setting Tertiary hospital. Participants Patients who had undergone cardiac surgery from October 2009 to June 2012. Interventions After HIT was suspected clinically, PaGIA and ELISA test were performed in all patients to diagnose HIT. In the patients included, anticoagulation was managed with a low dose of fondaparinux and daily monitoring of platelet count and anti-Xa level. Measurements and Main Results Of a total of 1,338 postoperative cardiac surgery patients, 15 patients were included (1.1%). Twelve of the 15 patients with HIT presented with renal failure and were under continuous renal replacement therapy. Two major bleeding events occurred during fondaparinux treatment, although platelet count and anti-Xa activity remained within the normal range. No thrombotic episodes were diagnosed. Conclusion With daily monitoring of anti-Xa activity, fondaparinux appeared to be a good alternative to heparin in the study group; however, randomized clinical trials are needed to establish the safety and efficacy of this drug in critically ill, previously HIT patients.