The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes

Alex C Spyropoulos1, Sharyl Magnuson1, Sei Keng Koh21Clinical Thrombosis Center, Lovelace Medical Center, Albuquerque, NM, USA; 2Department of Pharmacy, Singapore General Hospital, SingaporeAbstract: Heparin-induced thrombocytopenia (HIT) is an immunologic drug reaction characterized by paradoxical...

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Main Authors: Alex C Spyropoulos, Sharyl Magnuson, Sei Keng Koh
Format: Article
Language:English
Published: Dove Medical Press 2008-06-01
Series:Therapeutics and Clinical Risk Management
Online Access:http://www.dovepress.com/the-use-of-fondaparinux-for-the-treatment-of-venous-thromboembolism-in-a1892
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spelling doaj-a40dda2f725e4a868dd127feea32dc5b2020-11-24T21:48:56ZengDove Medical PressTherapeutics and Clinical Risk Management1176-63361178-203X2008-06-012008Issue 3653657The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushesAlex C SpyropoulosSharyl MagnusonSei Keng KohAlex C Spyropoulos1, Sharyl Magnuson1, Sei Keng Koh21Clinical Thrombosis Center, Lovelace Medical Center, Albuquerque, NM, USA; 2Department of Pharmacy, Singapore General Hospital, SingaporeAbstract: Heparin-induced thrombocytopenia (HIT) is an immunologic drug reaction characterized by paradoxical association with venous and arterial thrombosis. The syndrome is caused by IgG antibodies that are reactive against complexes of platelet factor 4 and heparin. Fondparinux does not bind to platelet factor 4, is structurally too short to induce an antibody response, and could in theory be a useful agent to treat HIT. A 69-year-old white female presented with a lower extremity extensive iliofemoral deep vein thrombosis after a right total knee arthroplasty and was subsequently found to have a pulmonary embolism. The patient was noted to have heparin flushes during her operation. Her platelet drop decreased >50% from baseline during initiation of antithrombotic therapy. She was started on subcutaneous fondaparinux 7.5 mg once daily injection. Her serotonin release assay and enzyme-linked immunosorbent assay for heparin antibodies were positive for HIT. Her platelet count nadir was 60 × 103/mm3 on day 5 and the platelet count rebounded after 8 days of fondaparinux therapy. No recurrent thrombotic or bleeding events were noted throughout her therapy. Anecdotal reports have shown that fondaparinux can be a useful agent to treat HIT with or without thrombosis.Keywords: fondaparinux, heparin-induced thrombocytopenia with thrombosis (HITT) http://www.dovepress.com/the-use-of-fondaparinux-for-the-treatment-of-venous-thromboembolism-in-a1892
collection DOAJ
language English
format Article
sources DOAJ
author Alex C Spyropoulos
Sharyl Magnuson
Sei Keng Koh
spellingShingle Alex C Spyropoulos
Sharyl Magnuson
Sei Keng Koh
The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
Therapeutics and Clinical Risk Management
author_facet Alex C Spyropoulos
Sharyl Magnuson
Sei Keng Koh
author_sort Alex C Spyropoulos
title The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
title_short The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
title_full The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
title_fullStr The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
title_full_unstemmed The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
title_sort use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
publisher Dove Medical Press
series Therapeutics and Clinical Risk Management
issn 1176-6336
1178-203X
publishDate 2008-06-01
description Alex C Spyropoulos1, Sharyl Magnuson1, Sei Keng Koh21Clinical Thrombosis Center, Lovelace Medical Center, Albuquerque, NM, USA; 2Department of Pharmacy, Singapore General Hospital, SingaporeAbstract: Heparin-induced thrombocytopenia (HIT) is an immunologic drug reaction characterized by paradoxical association with venous and arterial thrombosis. The syndrome is caused by IgG antibodies that are reactive against complexes of platelet factor 4 and heparin. Fondparinux does not bind to platelet factor 4, is structurally too short to induce an antibody response, and could in theory be a useful agent to treat HIT. A 69-year-old white female presented with a lower extremity extensive iliofemoral deep vein thrombosis after a right total knee arthroplasty and was subsequently found to have a pulmonary embolism. The patient was noted to have heparin flushes during her operation. Her platelet drop decreased >50% from baseline during initiation of antithrombotic therapy. She was started on subcutaneous fondaparinux 7.5 mg once daily injection. Her serotonin release assay and enzyme-linked immunosorbent assay for heparin antibodies were positive for HIT. Her platelet count nadir was 60 × 103/mm3 on day 5 and the platelet count rebounded after 8 days of fondaparinux therapy. No recurrent thrombotic or bleeding events were noted throughout her therapy. Anecdotal reports have shown that fondaparinux can be a useful agent to treat HIT with or without thrombosis.Keywords: fondaparinux, heparin-induced thrombocytopenia with thrombosis (HITT)
url http://www.dovepress.com/the-use-of-fondaparinux-for-the-treatment-of-venous-thromboembolism-in-a1892
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