Successful use of fondaparinux early after mechanical aortic valve replacement in a patient with a history of heparin-induced thrombocytopenia.

[heparin-induced thrombocytopenia]

Thromboembolic complications such as systemic embolization and valve thrombosis are a major concern early after mechanical valve replacement ; however , the benefit of anticoagulation must be weighed against the risk of early postoperative bleeding complications . Thromboembolic risk is also higher in the early postoperative period (less than 6 mo ) compared with the risk in the late postoperative period . Current evidence supports the use of unfractionated heparin or low -molecular-weight heparin early after valve replacement to prevent valve thrombosis or systemic embolization but provides no recommendations for the management of patients with a history of heparin-induced thrombocytopenia (HIT ), in which heparin products are contraindicated . We describe the use of fondaparinux early after aortic mechanical valve replacement in a 63 -year -old , 95 -kg woman with a history of HIT . Fondaparinux was initiated on postoperative day 2 at a prophylactic dose of 2 .5 mg subcutaneously daily ; the dose was increased to a therapeutic weight-based dose of 7 .5 mg subcutaneously daily on postoperative day 3 . Warfarin was initiated on postoperative day 1 , and fondaparinux was continued until a therapeutic international normalized ratio was achieved . The patient was discharged from the hospital receiving warfarin alone on postoperative day 6 . No signs or symptoms of thrombosis or bleeding were noted during or after fondaparinux therapy or at hospital follow-up visits . To our knowledge , this is the first case report to describe the use of fondaparinux within the first 48 hours after mechanical valve replacement in a patient with a history of HIT . This case suggests that fondaparinux may be a safe and effective option to prevent thromboembolic complications early after mechanical valve replacement when heparin products are contraindicated .