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.
Can you use fondaparinux for HIT?
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.
Why is fondaparinux safe 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.
Does fondaparinux cause thrombocytopenia?
It seems plausible that anti-PF4/heparin antibodies generated through previous exposure to fondaparinux resulted in a clinical syndrome of HIT. The rapidity of thrombocytopenia with thrombosis suggests an anamnestic response to preformed anti-PF4/heparin antibodies upon exposure to enoxaparin.
What causes HIT thrombosis?
The antibody binds to this complex and the platelets are destroyed. This disruption of platelets can lead to the formation of new blood clots in patients with immune-mediated HIT. The result can be a deep vein thrombosis (in the veins of the thigh or pelvis), pulmonary embolism, or even a heart attack or stroke.
What is treatment for HIT?
A direct thrombin inhibitor, such as lepirudin, danaparoid or argatroban, is considered the agent of choice for treatment of HIT.
What anticoagulant can be safely used in patients with HIT?
A direct thrombin inhibitor, such as lepirudin, danaparoid or argatroban, is considered the agent of choice for treatment of HIT. Warfarin should not be used until the platelet count has recovered.
Can apixaban be used in 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.
How does heparin cause HIT?
HIT is caused by the formation of antibodies that activate platelets following heparin administration. The principal antigen is a complex of heparin and platelet factor 4 (PF4), a small positively charged molecule of uncertain biological function, normally found in α‐granules of platelets.
Is fondaparinux an alternative antithrombotic medication used in patients with hit?
Due to limited data supporting its use in patients with HIT, the current American College of Chest Physicians (ACCP) Evidence Based Clinical Practice Guidelines (9 th Edition) recommend fondaparinux as one alternative antithrombotic medication that can be used in patients with HIT.
Does fondaparinux affect platelet count?
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.
Does fondaparinux interact with heparin-induced thrombocytopenia antibodies?
Abstract 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.
Is fundfondaparinux a heparin product?
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. Due to limited data supporting its use in patients with HIT,
