College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Ann Hematol. 2018 Nov;97(11):2055-2059. doi: 10.1007/s00277-018-3422-6. Epub 2018 Jul 12.
Heparin-induced thrombocytopenia (HIT) is a serious complication of the administration of heparin and its derivatives. Non-heparin anticoagulants such as argatroban and fondaparinux are widely used in the management of HIT to compare the effectiveness of argatroban and fondaparinux in the resolution of thrombocytopenia and to compare clinical outcomes in patients with isolated HIT. A retrospective cohort analysis was performed at King Abdulaziz Medical City (KAMC) on patients diagnosed with isolated HIT between 31 Jan, 2014 and 30 June, 2017. Demographics data, non-heparin anticoagulants, related laboratory results, and clinical outcomes were retrieved and analysed. The cohort comprised a total of 95 adult patients who received either argatroban (56 patients) or fondaparinux (39 patients) for isolated HIT. The median age and sex distribution were similar in both argatroban and fondaparinux groups. The mean (+ SD) time (in days) for the resolution of thrombocytopenia was 3.5 (± 1.8) for patients who received argatroban and 3.7 (± 1.7) for patients administered fondaparinux (p = 0.843). Thromboembolic events occurred in five patients (8.9%) administered argatroban and in three patients (7.7%) administered fondaparinux (p = 0.382). There was no significant difference in the rates of bleeding or death (p = 0.829); however, the small number of cases limits our ability to draw conclusions about these outcomes. In this retrospective study, fondaparinux and argatroban were similarly effective in resolving thrombocytopenia, preventing further thromboembolic events, and maintaining safety in patients with confirmed HIT. To confirm this observation, larger prospective studies are needed.
肝素诱导的血小板减少症（HIT）是肝素及其衍生物给药的严重并发症。阿加曲班和磺达肝素等非肝素抗凝剂广泛用于 HIT 的治疗，以比较阿加曲班和磺达肝素在血小板减少症缓解方面的有效性，并比较确诊 HIT 患者的临床结局。在 2014 年 1 月 31 日至 2017 年 6 月 30 日期间，对阿卜杜勒阿齐兹国王医疗城（KAMC）诊断为孤立性 HIT 的患者进行了回顾性队列分析。检索并分析了人口统计学数据、非肝素抗凝剂、相关实验室结果和临床结局。该队列共纳入 95 例接受阿加曲班（56 例）或磺达肝素（39 例）治疗的成年孤立性 HIT 患者。阿加曲班和磺达肝素组的中位年龄和性别分布相似。接受阿加曲班治疗的患者血小板减少症缓解的平均（+标准差）时间为 3.5（±1.8）天，接受磺达肝素治疗的患者为 3.7（±1.7）天（p=0.843）。5 例（8.9%）接受阿加曲班治疗的患者发生血栓栓塞事件，3 例（7.7%）接受磺达肝素治疗的患者发生血栓栓塞事件（p=0.382）。出血或死亡发生率无显著差异（p=0.829）；然而，由于病例数量较少，我们无法就这些结局得出结论。在这项回顾性研究中，磺达肝素和阿加曲班在缓解血小板减少症、预防进一步血栓栓塞事件和确保确诊 HIT 患者的安全性方面同样有效。为了证实这一观察结果，需要进行更大规模的前瞻性研究。
