What is the role of fondaparinux in the treatment of hit?
Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists.
Can fondaparinux be used to treat heparin-induced thrombocytopenia in critically ill patients?
Rationale: Fondaparinux, as a factor Xa-inhibitor, is used off label to manage heparin-induced thrombocytopenia (HIT), but little experience with HIT patients has been reported in the literature. Moreover, the use of fondaparinux for full anticoagulation in critically ill patients with HIT and renal insufficiency is limited.
Is fondaparinux a safe and convenient treatment for hepatocellular carcinoma (hit)?
Use of fondaparinux, a selective factor Xa inhibitor, is common for treatment of HIT, albeit without Food and Drug Administration approval. While these data are small in number, and limited by the retrospective design, they provide reassurance that fondaparinux may be a safe and convenient treatment for HIT.
Is fondaparinux an alternative for anticoagulation treatment in hit and kidney dysfunction?
Our experience suggests that fondaparinux might be an alternative for anticoagulation treatment in patients with HIT and kidney dysfunction if another anticoagulant (argatroban) is unavailable.
Why can you use fondaparinux in HIT?
Patients with HIT have antibodies that react with a complex of platelet factor 4 and heparin, but these antibodies appear to have minimal or no reactivity with fondaparinux.
Why does fondaparinux not cause HIT?
Fondaparinux does not cause HIT because it does not bind to PF4. In contrast to LMWH, there is no cross-reactivity of fondaparinux with HIT antibodies. Consequently, fondaparinux appears to be effective for treatment of HIT patients, although large clinical trials supporting its use are lacking.
What anticoagulant can be used with HIT?
A direct thrombin inhibitor, such as lepirudin, danaparoid or argatroban, is considered the agent of choice for treatment of HIT.
Can fondaparinux be used in heparin induced thrombocytopenia?
Fondaparinux is an antithrombin‐dependent, synthetic anti‐factor Xa‐inhibitor that is used off‐label as an alternative anticoagulant in the treatment of life‐threatening immune heparin‐induced thrombocytopenia (HIT).
How is fondaparinux different from heparin?
Thins the blood and treats blood clots. Arixtra (fondaparinux) is effective at treating clots, but it can increase your risk of bleeding. Prevents blood clots.
Is fondaparinux the same as heparin?
Fondaparinux is essentially a synthetic, short molecule shaped like heparin. It exerts no activity against factor IIa, working purely via inhibition of Xa. All of these agents are effective only against fluid-phase clotting factors.
Can you use DOAC for HIT?
DOACs also prevented new or recurrent thromboembolisms in 98% (102) of cases, with only 3% (3) of patients experiencing bleeding events. Given the growing evidence and promising results, the most recent guidelines released by ASH for the management of HIT in 2018 added DOACs as an option for the management of HIT.
Can you use apixaban for HIT?
Patients with Heparin Induced Thrombocytopenia (HIT) will receive Apixaban, at an initial dose of 10 mg orally twice a day for 7 days followed by 5 mg twice a day for a total of 30 days. Apixaban is an anticoagulant that works by inhibiting the coagulation factor, Factor Xa.
Can you use heparin after HIT?
Full courses of heparin should be avoided in patients with a history of HIT. Patients with a history of HIT are more likely to develop platelet-activating antibodies (SRA seroconversion) within their anti-PF4/heparin response and thus to develop HIT if they receive postoperative heparin.
Does fondaparinux affect platelet?
Using 3 functional assays, our study shows that, in most cases, fondaparinux does not activate platelets in the presence of sera obtained from patients with HIT; the platelet aggregation test was negative with all evaluable sera, the HIPA test was positive with only one serum (3.0%), and the SRA was positive with only ...
When do you use enoxaparin and fondaparinux?
In patients who were treated for ACS, fondaparinux might be a better choice when compared to enoxaparin in terms of short to midterm bleeding events. This result was mainly applicable to patients with NSTEMI.
Why is fondaparinux given in Nstemi?
Importance Fondaparinux was associated with reduced major bleeding events and improved survival compared with low-molecular-weight heparin (LMWH) in a large randomized clinical trial involving patients with non–ST-segment elevation myocardial infarction (NSTEMI).
What is the advantage of fondaparinux over heparin?
Importance Fondaparinux was associated with reduced major bleeding events and improved survival compared with low-molecular-weight heparin (LMWH) in a large randomized clinical trial involving patients with non–ST-segment elevation myocardial infarction (NSTEMI).
Does Arixtra cause HIT?
Fondaparinux (Arixtra) is an anticoagulant that shares the same pentasaccharide sequence as UFH and LMWH for the binding to antithrombin, however it has no extra chain and thus, is not considered a heparin product. It is also known to not cause HIT, as seen with UFH and LMWH.
What is the difference between enoxaparin and fondaparinux?
Fondaparinux is a factor Xa inhibitor and does not inhibit thrombin (IIa) [8]. Enoxaparin on the other hand, binds to antithrombin to form a complex molecule that can irreversibly inactivate clotting factor Xa and it has less activity against thrombin [9]. This is how these two anticoagulants work.
What is the mechanism of action of fondaparinux?
The mechanism of action of fondaparinux is as a Factor Xa Inhibitor.
Study Questions
How safe and effective are different anticoagulants, including fondaparinux, for treatment of heparin-induced thrombocytopenia (HIT)?
Methods
Using a national, multicenter registry study design, hospitalized patients who were diagnosed with HIT (4T scores ≥4 points) and treated with ≥1 dose of approved anticoagulants (argatroban, lepirudin, danaparoid) or fondaparinux were investigated.
Results
Of 195 patients included, 46 (23.6%) were treated with argatroban, 4 (2.1%) with lepirudin, 61 (31.3%) with danaparoid, and 84 (43.1%) with fondaparinux. The composite endpoint of HIT-specific complications occurred in 11.7% of patients treated with approved anticoagulants and 0.0% of patients with fondaparinux treatment.
Conclusions
The authors concluded that fondaparinux is effective and safe in suspected acute HIT.
Perspective
For patients with HIT, it is critical to initiate nonheparin anticoagulation in order to prevent both thrombotic and bleeding complications. Use of fondaparinux, a selective factor Xa inhibitor, is common for treatment of HIT, albeit without Food and Drug Administration approval.
What is Fondaparinux used for?
Fondaparinux is currently indicated for the prevention of VTE in patients undergoing orthopedic procedures and abdominal surgery, for the treatment of venous thromboembolic disease, the management or unstable angina, and non-ST or ST segment elevation myocardial infarction.
Is a positive HIT a positive SRA?
We considered a positive diagnosis of HIT in patients who had either a positive SRA or in whom a diagnosis of HIT was documented by an attending hematologist during hospital admission , since not all patients had an SRA done. Criteria for a diagnosis of HIT were based on Greinacher and Warkentin’s definition and included a high clinical likelihood in the presence of a positive HIT-ELISA or an intermediate likelihood in the presence of a strongly positive HIT-ELISA. 32
Is Fondaparinux the same as Argatroban?
Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists.
Is Fondaparinux effective for thrombocytopenia?
Current guidelines for heparin-induced thrombocytopenia (HIT) management recommend heparin cessation and switching to a nonheparin anticoagulant (ie, argatroban, danaparoid) upon clinical suspicion. Fondaparinux may be effective but information supporting its use is limited.
Is lepirudin a prophylaxis?
Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.
Is hirudin a good anticoagulant?
Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia: a prospective study.
Does heparin cause platelet derived microparticles?
Sera from patients with heparin-induced thrombocytopenia generate platelet-derived microparticles with procoagulant activity: an explanation for the thrombotic complications of heparin-induced thrombocytopenia.
Is fondaparinux safe for HIT?
Fondaparinux is an attractive anticoagulant therapy in patients with HIT. There is still the need for larger randomized trials evaluating the true effica cy, appropriate dose, safe duration of treatment, and the true incidence of HIT associated with fondaparinux.
Does fondaparinux bind to heparin?
Fondaparinux, a pentasaccharide which selectively binds to antithrombin III, has negligible to no cross-reactivity with heparin-induced thrombocytopenia (HIT) antibodies in in vitro studies. The lack of cross-reactivity suggests a potential role in the management of HIT, and indeed, there are several such case reports and small studies. These published data have used both the prophylactic and weight-based treatment doses. However, due to the small possibility of developing HIT with thromboembolic complications while receiving fondaparinux, it is suggested that the appropriate weight-based treatment dose be used. In all these reports, fondaparinux provided adequate anticoagulation, prevented further thromboembolic events, and platelet counts returned to normal. However, there have been a couple of case reports on possible HIT or HIT-like syndrome secondary to fondaparinux use.
Is Fondaparinux a good anticoagulant?
Fondaparinux is an attractive anticoagulant therapy in patients with HIT. There is still the need for larger randomized trials evaluating the true efficacy, appropriate dose, safe duration of treatment, and the true incidence of HIT associated with fondaparinux. Fondaparinux is an attractive anticoagulant therapy in patients with HIT.
