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Rivaroxaban for arterial thrombosis related to heparin-induced thrombocytopenia.
[heparin-induced thrombocytopenia]
Heparin-induced
thrombocytopenia
(
HIT
)
may
be
a
critical
condition
in
intensive
care
patients
.
Diagnosis
of
HIT
is
often
difficult
,
and
management
too
,
as
physicians
have
usually
a
limited
experience
with
alternative
anticoagulants
.
A
36
-
year
-old
man
was
admitted
for
orthopaedic
surgery
after
a
trauma
causing
a
fracture
of
the
sacrum
and
right
ankle
.
Anticoagulant
prophylaxis
was
made
by
nadroparin
(
3800
 
IU
/
day
)
.
But
the
patient
developed
less
than
10
days
after
nadroparin
exposure
a
significant
drop
in
platelet
count
.
The
diagnosis
of
HIT
was
based
on
the
pretest
clinical
score
and
demonstration
of
platelet
factor
4
and
heparin
antibodies
.
Fondaparinux
was
transiently
administered
but
was
replaced
3
days
later
by
rivaroxaban
(
15
 
mg
twice
a
day
during
21
days
then
20
 
mg
/
day
)
,
after
the
demonstration
of
an
acute
thrombosis
of
the
left
radial
artery
.
Platelet
count
returned
to
normal
range
and
a
partial
recanalization
of
arterial
thrombosis
was
noted
.
The
use
of
rivaroxaban
in
this
indication
is
of
theoretical
interest
but
requires
further
experience
.
