Emerging Therapy Options in Heparin-Induced Thrombocytopenia.

[heparin-induced thrombocytopenia]

Heparin-induced thrombocytopenia (HIT ) is a life and limb -threatening thrombotic complication of heparin , which is the result of platelet activation by anti-PF 4 /heparin antibodies . With lepirudin and danaparoid no longer available in the US , treatment options are limited to argatroban , fondaparinux (off-label use ) and bivalirudin (for patients undergoing percutaneous coronary intervention ). Both argatroban and bivalirudin are parenteral drugs , require close monitoring and hospitalization . Fondaparinux is contraindicated in patients with significant renal impairment and is associated with a small risk of HIT . Anticoagulants approved for thromboprophylaxis and management of thromboembolic conditions such as rivaroxaban , dabigatran , and apixaban have fixed oral dose , rapid onset of action and does not require monitoring . These novel agents do not interact with anti-PF 4 /heparin antibody and offer attractive therapy options for HIT . Their utility in HIT has been supported by a few clinical reports , however , larger studies are needed before they can be utilized in clinical practice . Therapeutic plasma exchange has been utilized with some success in patients with HIT , who need heparin reexposure for cardiac surgery but their safety and efficacy needs further exploration . 2 -O , 3 -O desulfated heparin , which lacks any anticoagulant effect , has been shown to reduce the development of HIT in murine models . Finally , novel targets based on the molecular pathogenesis of HIT are being studied for therapeutic drug development . We hope that the availability of novel therapies in the future will expand the options available for the management of HIT .

Diseases
Validation

Diseases presenting "however" symptom

adrenal incidentaloma

alexander disease

alpha-thalassemia

aromatase deficiency

benign recurrent intrahepatic cholestasis

cushing syndrome

dedifferentiated liposarcoma

dracunculiasis

dystrophic epidermolysis bullosa

esophageal carcinoma

focal myositis

heparin-induced thrombocytopenia

hodgkin lymphoma, classical

hydrocephalus with stenosis of the aqueduct of sylvius

junctional epidermolysis bullosa

krabbe disease

lamellar ichthyosis

megacystis-microcolon-intestinal hypoperistalsis syndrome

monosomy 21

neuralgic amyotrophy

oculocutaneous albinism

omenn syndrome

primary hyperoxaluria type 1

pyruvate dehydrogenase deficiency

sneddon syndrome

thoracic outlet syndrome

von hippel-lindau disease

wiskott-aldrich syndrome

x-linked adrenoleukodystrophy

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