Fondaparinux versus direct thrombin inhibitor therapy for the management of heparin-induced thrombocytopenia (HIT) - Bridging the River Coumarin

Abstract

In summary, fondaparinux has the likely advantage (vs. DTI) of improving bridging to warfarin, but (unlike DTI) its efficacy as a primary non-heparin anticoagulant for severe HIT-associated hypercoagulability is not established. How can physicians deal with this therapeutic conundrum? One possibility - not yet described in the literature, but theoretically attractive - is to utilize a DTI during the thrombocytopenic phase of HIT; however, once the platelet count has substantially recovered, rather than performing DTI-warfarin bridging, a DTI-fondaparinux transition can be performed. In this way, one circumvents the "off-label" use of fondaparinux as the primary treatment of HIT, while at the same time avoiding the complexity (and risk) of DTI-warfarin overlap. This study by Lobo et al. provides lots of ideas for the management of HIT. © 2008 Schattauer GmbH, Stuttgart.