Direct Oral Anticoagulants as Successful Treatment of Heparin-Induced Thrombocytopenia: A Parisian Retrospective Case Series

Julie Carré; Hippolyte Guérineau; Christine Le Beller; Laëtitia Mauge; Benoit Huynh; Roya Nili; Benjamin Planquette; Sylvain Clauser; David M Smadja; Dominique Helley; Agnès Lillo-Le Louet; Nicolas Gendron; Leyla Calmette

doi:10.3389/fmed.2021.713649

Direct Oral Anticoagulants as Successful Treatment of Heparin-Induced Thrombocytopenia: A Parisian Retrospective Case Series

Front Med (Lausanne). 2021 Aug 5:8:713649. doi: 10.3389/fmed.2021.713649. eCollection 2021.

Authors

Julie Carré^{1

2}, Hippolyte Guérineau³, Christine Le Beller^{1

4}, Laëtitia Mauge^{2

5}, Benoit Huynh⁶, Roya Nili^{1

4}, Benjamin Planquette^{1

7}, Sylvain Clauser³, David M Smadja^{1

8}, Dominique Helley^{2

5}, Agnès Lillo-Le Louet^{1

4}, Nicolas Gendron^{1

8}, Leyla Calmette³

Affiliations

¹ Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France.
² Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France.
³ Hematology-Immunology-Transfusion Department, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France.
⁴ Pharmacovigilance Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France.
⁵ INSERM UMR-S970, Centre de Recherche Cardiovasculaire de Paris, Paris, France.
⁶ Hematology Department, Institut Mutualiste Montsouris, Paris, France.
⁷ Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France.
⁸ Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France.

Abstract

Background: Heparin-induced thrombocytopenia (HIT) is a prothrombotic life-threatening disorder caused by an adverse reaction to heparin exposure. In this context, it is imperative to stop heparin immediately and to replace it by a non-heparin anticoagulant therapy. Despite their advantages, the use of direct oral anticoagulants (DOACs) is only emerging for HIT treatment, and their use remains rare. Objective: To improve our knowledge on the emerging role of DOACs as treatment of HIT and give an overview of our local practices in this context. Patients/Methods: This is a multi-centric retrospective case series of HIT patients referred to our Parisian pharmacovigilance network and treated with DOACs. Results: We report the cases of seven patients from four healthcare centers, diagnosed with HIT (4T score ≥ 4, positive anti-PF4/heparin immunoassay and positive serotonin-release assay) and treated with DOACs. After a few days on substitutive parenteral treatment (n = 6) or directly at HIT diagnosis (n = 1), these patients were treated with either rivaroxaban (n = 6) or apixaban (n = 1) during acute HIT phase. Mean time to platelet count recovery after heparin discontinuation was 3.3 days (range 3-5). No patient experienced major or clinically relevant non-major bleeding or thrombosis that could be related to DOAC treatment during follow-up. Conclusions: Our cases studies are consistent with recent guidelines credit to the potential and safe use of DOAC during acute HIT in clinically stable patients.

Keywords: apixaban; direct oral anticoagulant; heparin-induced thrombocytopenia; platelets; rivaroxaban; thrombosis.