Sartori Michelangelo, Favaretto Elisabetta, Cini Michela, Legnani Cristina, Cosmi Benilde
Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Pad. 2, Via Albertoni, 15, 40138, Bologna, Italy,
J Thromb Thrombolysis. 2015 Oct;40(3):392-4. doi: 10.1007/s11239-015-1208-4.
Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition and it is associated with increased in vivo thrombin generation that needs to be treated with non-heparin anticoagulants such as direct thrombin inhibitors (DTIs). DTIs require parenteral administration and are associated with a non negligible risk of major bleeding. We describe a case of HIT treated with rivaroxaban, a direct oral factor Xa inhibitor which could be used to inhibit the generation of thrombin, instead of DTIs. A 68 year-old man with a thrombosis confined to the internal gastrocnemius and soleal veins developed HIT during enoxaparin 80 mg twice a day. Enoxaparin was stopped and rivaroxaban 20 mg once a day was started. Platelet count returned to base line after 6 days from enoxaparin withdrawal. After 3 months rivaroxaban was stopped and the patient had an uneventful course. This case report supports the hypothesis that rivaroxaban may be candidate for treatment of HIT, and larger studies are justified.
肝素诱导的血小板减少症（HIT）是一种血栓前状态，与体内凝血酶生成增加有关，需要使用非肝素抗凝剂（如直接凝血酶抑制剂（DTIs））进行治疗。DTIs需要胃肠外给药，且严重出血风险不可忽视。我们描述了一例使用利伐沙班治疗的HIT病例，利伐沙班是一种直接口服的Xa因子抑制剂，可用于抑制凝血酶生成，而非DTIs。一名68岁男性，血栓局限于腓肠肌内侧头和比目鱼肌静脉，在每天两次使用80mg依诺肝素期间发生了HIT。停用依诺肝素，开始每天一次使用20mg利伐沙班。停用依诺肝素6天后血小板计数恢复至基线水平。3个月后停用利伐沙班，患者病程平稳。本病例报告支持利伐沙班可能是治疗HIT的候选药物这一假设，因此有必要进行更大规模的研究。
