Direct-thrombin inhibitor utilization in patients with heparin-induced thrombocytopenia and undergoing catheter-directed thrombolysis: A summary of published case reports

Abstract

Background: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT. Objectives: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT. Methods and Results: We included 6 case reports in our analysis after searching for peer-reviewed articles and case reports in multiple research engines. Four of the 6 cases used argatroban, and 2 cases used bivalirudin. Alteplase was used in all of the 6 cases. All cases used lower activated partial thromboplastin time target. The average initial dose of alteplase ranged from 0.5 to 3 mg/h. The average duration of CDT was 26 hours (SD, 13 hours). Five patients (83%) survived after the procedure, and no complications were reported. Conclusions: The use of DTIs might be safe and effective in selected patients with heparin-induced thrombocytopenia and undergoing CDT.