Is Fondaparinux an Effective Alternative Anticoagulant in Patients With Heparin Induced Thrombocytopenia Type II? A Case Report and Review of the Literature
Although rare, heparin induced thrombocytopenia (HIT) is one of the most feared complications of heparin therapy. It is an antibody mediated, acquired and transient thrombotic disorder following exposure to heparin. Unfractionated heparin is the standard anticoagulation used in hemodialysis sessions and hemodialysis patients who are continually exposed to heparin are at increased risk for HIT. We report a 75 year old male patient with acute on chronic renal failure who subsequently developed HIT while on hemodialysis. The patient was presented with deep vein thrombosis and successfully treated with fondaparinux. In this report we also review the off label use of fondaparinux for the treatment and prophylaxis of thrombosis in patients with HIT. As fondaparinux is too small to be recognized by the majority of heparin reactive antibodies it could be a reasonable alternative anticoagulant for symptomatic HIT patients where licensed drugs like lepirudin and danaparoid are not available. Turkish Baslik: Fondaparinuks Heparinin Indukledigi Trombositopeni Hastalarinda Etkili Bir Alternatif Antikoagulan Midir? Olgu Sunumu ve Literatur Derlemesi Anahtar Kelimeler: Heparine bagli trombositopeni, tromboz, hemodiyaliz, fondaparinuks Heparine bagli trombositopeni (HIT) nadir olmasina karsin heparin tedavisinin en cok korkulan komplikasyonlarindan biridir. Heparine bagli trombositopeni heparin ile temas sonrasi olusan, antikor aracili edinsel ve gecici bir trombotik bozukluktur. Fraksiyone olmayan heparin hemodiyaliz sirasinda kullanilan standart antikoagulandir ve heparin ile surekli temas eden hemodiyaliz hastalarinda HIT riski artmistir. Burada kronik zeminde akut bobrek yetersizligi olan ve hemodiyaliz sonrasinda HIT gelisen 75 yasinda bir erkek hastayi bildiriyoruz. Hastada derin ven trombozu saptandi ve fondaparinuks ile basariyla tedavi edildi. Bu yazimizda ayrica HIT hastalarinda gelisen trombozun profilaksi ve tedavisinde fondaparinuksun endikasyon disi kullanimini derledik. Fondaparinuks heparin ile reaksiyon veren antikorlarin cogunlugunca taninmayacak kadar kucuk oldugundan lepirudin ve danaparoid gibi lisansli ilaclarin bulunmadigi durumlarda, semptomatik HIT hastalari icin mantikli bir alternatif antikoagulan olabilir.