Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
J Thromb Haemost. 2014 Jul;12(7):1044-53. doi: 10.1111/jth.12592. Epub 2014 Jun 19.
Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated response to unfractionated heparin and, less commonly, low molecular weight heparin. It is associated with a high thrombotic risk and the potential for limb and life-threatening complications. Argatroban is the only approved and currently available anticoagulant for HIT treatment in the USA.
To report safety and efficacy outcomes with bivalirudin for HIT treatment.
We retrospectively examined records from our registry of patients with a suspected, confirmed or previous history of HIT and who had received bivalirudin for anticoagulation in a single tertiary-care center over a 9-year period.
We identified 461 patients who received bivalirudin: 220 (47.7%) were surgical patients, and 241 (52.3%) were medical patients. Of this population, 107 (23.2%) were critically ill, and 109 (23.6%) were dialysis-dependent. Suspected, confirmed and previous history of HIT were reported in 262, 124 and 75 patients, respectively. Of 386 patients with suspected or confirmed HIT, 223 patients (57.8%) had thrombosis at HIT diagnosis. New thrombosis was identified in 21 patients (4.6%) while they were on treatment with therapeutic doses of bivalirudin. No patient required HIT-related amputation. Major bleeding occurred in 35 patients (7.6%). We found a significant increase in major bleeding risk in the critically ill population (13.1%; odds ratio 2.4, 95% confidence interval 1.2-4.9, P = 0.014). The 30-day all-cause mortality rate was 14.5% (67 patients), and eight of 67 (1.7%) deaths were HIT-related.
Bivalirudin may be an effective and safe alternative option for the treatment of both suspected and confirmed HIT, and appears to reduce the rate of HIT-related amputation.
肝素诱导的血小板减少症（HIT）是一种对未分级肝素和较低分子量肝素的免疫介导的不良反应。它与高血栓形成风险和肢体及生命威胁性并发症的潜在风险相关。阿加曲班是目前唯一在美国批准用于 HIT 治疗的抗凝药物。
报告比伐卢定治疗 HIT 的安全性和疗效结果。
我们回顾性地检查了我们的 HIT 患者登记处的记录，这些患者在一家三级保健中心接受了比伐卢定抗凝治疗，时间跨度为 9 年。
我们确定了 461 名接受比伐卢定治疗的患者：220 名（47.7%）为手术患者，241 名（52.3%）为内科患者。在这一人群中，107 名（23.2%）患者病情危重，109 名（23.6%）患者依赖透析。分别有 262 例、124 例和 75 例患者报告有疑似、确诊和既往 HIT 病史。在 386 例疑似或确诊 HIT 的患者中，有 223 例（57.8%）在 HIT 诊断时存在血栓形成。在接受治疗剂量的比伐卢定治疗期间，有 21 例（4.6%）患者出现新的血栓形成。没有患者需要进行与 HIT 相关的截肢。35 例（7.6%）患者发生主要出血。我们发现，危重患者的主要出血风险显著增加（13.1%；优势比 2.4，95%置信区间 1.2-4.9，P=0.014）。30 天全因死亡率为 14.5%（67 例），67 例死亡中有 8 例（1.7%）与 HIT 相关。
比伐卢定可能是疑似和确诊 HIT 的有效且安全的替代治疗选择，并且似乎降低了与 HIT 相关的截肢率。
