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A retrospective evaluation of fondaparinux for confirmed or suspected heparin-induced thrombocytopenia in left-ventricular-assist device patients.
[heparin-induced thrombocytopenia]
Thrombotic
events
are
a
common
complication
of
left
ventricular
assist
device
placement
and
warrant
prophylactic
anticoagulation
.
Heparin
is
the
most
common
anticoagulant
used
for
prophylaxis
of
thrombotic
events
in
left
ventricular
assist
device
patients
as
a
transition
to
oral
anticoagulants
but
carries
the
risk
of
heparin-induced
thrombocytopenia
.
Limited
data
is
available
for
the
treatment
of
heparin-induced
thrombocytopenia
in
this
patient
population
.
We
report
an
evaluation
of
8
left
ventricular
assist
device
patients
with
suspected
or
confirmed
HIT
started
on
fondaparinux
at
the
time
of
heparin-induced
platelet
-
factor
-
4
antibody
positivity
.
Adult
patients
were
reported
if
they
were
heparin-induced
platelet
antibody
positive
,
tested
via
enzyme-linked
immunusorbent
assay
,
post-operative
after
left-
ventricular
assist
device
,
and
were
initiated
on
fondaparinux
at
the
time
of
heparin-induced
platelet
antibody
positivity
.
Waiver
of
informed
consent
was
granted
from
the
institutional
review
board
.
Baseline
demographics
,
clinical
course
of
HIT
,
safety
and
efficacy
variables
were
collected
.
Eight
patients
receiving
fondaparinux
were
identified
and
included
in
this
report
.
The
patient
group
was
on
average
49
years
old
,
weighing
95
kg
,
with
calculated
BMI
28
.
8
and
consisted
primarily
of
Caucasian
males
.
Three
patients
developed
new
thromboses
after
initiation
of
fondaparinux
for
heparin-induced
thrombocytopenia
.
Only
one
patient
had
a
major
bleeding
event
of
an
overt
bleed
after
initiation
of
fondaparinux
therapy
.
Given
the
lack
of
major
bleeding
in
this
evaluation
,
fondaparinux
could
be
a
potentially
safe
treatment
option
for
left
ventricular
assist
device
patients
that
are
heparin-induced
platelet
antibody
positive
pending
confirmatory
testing
results
.
Given
the
development
of
new
thromboses
in
3
of
8
patients
,
concern
exists
about
the
efficacy
of
fondaparinux
in
this
patient
population
.
Significant
limitations
exist
regarding
these
conclusions
in
this
evaluation
.
Controlled
,
systematic
evaluations
are
necessary
to
delineate
safety
and
efficacy
of
fondaparinux
for
heparin-induced
thrombocytopenia
in
this
population
.
Diseases
Validation
Diseases presenting
"warrant prophylactic anticoagulation"
symptom
heparin-induced thrombocytopenia
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