Fondaparinux as a Treatment Option for Heparin-Induced Thrombocytopenia

Stella Papadopoulos, Pharm.D.; Jeremy D. Flynn, Pharm.D.; Daniel A. Lewis, Pharm.D.

Disclosures

Pharmacotherapy. 2007;27(6):921-926. 

In This Article

Nonheparin Anticoagulants

Two categories of nonheparin agents that will inhibit the increased thrombin production in this clinical situation include the direct thrombin inhibitors—argatroban, lepirudin, and bivalirudin—and the two factor Xa inhibitors—danaparoid and fondaparinux.[2,3] Guidelines from the American College of Chest Physicians recommend the direct thrombin inhibitors as first-line therapy for HIT. Two of these agents, lepirudin and argatroban, are approved by the United States Food and Drug Administration (FDA) for use in patients with active HIT.[2] Bivalirudin is approved for use in patients with HIT who undergo percutaneous coronary intervention (PCI).[13]

Danaparoid, a low-molecular-weight heparinoid, binds to antithrombin III to preferentially inactivate factor Xa. It has some factor IIa activity. Danaparoid is no longer available in the United States, but it is approved as an alternative anticoagulant for treatment and prevention of HIT-related thrombosis in other countries.[1–3] Fondaparinux sodium is a synthetic molecule that indirectly inhibits factor Xa by binding to antithrombin III, resulting in a decrease in thrombin generation.[1,2,14–16] Although fondaparinux is not approved for use in patients with HIT, a small body of clinical experience indicates its efficacy in the setting of immune-mediated thrombocytopenia.

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