Heparin-induced thrombocytopenia

Gowthami M. Arepally

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  • Medical Management of Heparin-Induced Thrombocytopenia: Pharmacoeconomic Considerations
    • Jason H Karnes, Assistant Professor University of Arizona
    • Other Contributors:
      • Brian Erstad, Professor
      • Ahmed Aljabri, Fellow
      • Yvonne Huckleberry, Pharmacist
      • Mahdi Gharaibeh, Pharmacist
      • Hussam I Kutbi, Pharmacist
      • Yuval Raz, Physician
      • Seongseok Yun, Physician
      • Ivo Abraham, Professor

    We read with great interest the recent review by Dr. Arepally entitled “Heparin-Induced Thrombocytopenia,” which provides an objective overview of the evidence regarding the pathogenesis and clinical features of this potentially catastrophic adverse drug reaction. We read with particular interest the sections dealing with treatment of HIT since few agents are available, especially in the US. Notably, danaparoid is not available in the US and argatroban is the only FDA-approved option for medical treatment of HIT. Dr. Arepally provides a concise and objective review of the available management options and highlights the lack of head-to-head clinical trials comparing these agents.
    This lack of clinical trials makes clear recommendations difficult and often forces clinicians to rely on personal experiences and drug characteristics rather than practice evidence-based medicine. Argatroban and bivalirudin have the advantage of a more rapid elimination and argatroban has an advantage in the setting of comprimised renal function. However, fondaparinux has a relatively simple administration that reduces effort associated with preparation, administration, and monitoring. Our recently published article in Blood (published after Dr. Arepally’s article was accepted) evaluated the pharmacoeconomics of these agents.1,2 Based on our results, fondaparinux provided an attractive clinical and economic alternative to argatroban and bivalirudin, affording large reductions in cost...

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    Conflict of Interest:
    None declared.