Abstract

Background

Fondaparinux is commonly used for treatment of heparin‐induced thrombocytopenia (HIT) despite lack of approval for this indication. High quality randomized controlled trials of this agent are unlikely to be forthcoming.

Objectives

The objective of this systematic review is to update the literature on the efficacy and safety of fondaparinux for treatment of confirmed and probable HIT based on the available evidence.

Methods

Primary articles were identified using Web of Science and PubMed database searches for English‐language studies from January 2006 to November 2017. Selected studies enrolled consecutive adult patients who received fondaparinux as the primary anticoagulant to treat acute HIT; confirmed the diagnosis by serological testing with a serotonin‐release assay; heparin‐induced platelet activation assay or enzyme‐linked immunosorbent assay; provided clinical criteria used to define HIT and reported clinically important outcomes.

Results

A total of 9 studies were identified with 154 HIT positive patients. Ten experienced a new thrombotic event while receiving fondaparinux (6.5%, 95% CI, 3.4 to 11.7%) and 26 experienced major bleeding (16.9%, 95% CI, 11.7 to 23.6%). Mortality due to thrombosis or bleeding was reported in 5 patients (3.2%, 95% CI, 1.2 to 7.6%).

Conclusions

Fondaparinux appears to be an effective and safe anticoagulant for treatment of acute HIT despite the absence of randomized trials. Caution should exercised when using fondaparinux in patients with renal insufficiency.

Details

Title
Systematic review of fondaparinux for heparin‐induced thrombocytopenia: When there are no randomized controlled trials
Author
Lori‐Ann Linkins 1 ; Hu, George 2 ; Warkentin, Theodore E 3   VIAFID ORCID Logo 

 Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada 
 McMaster University, Hamilton, Ontario, Canada 
 Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Hamilton Regional Laboratory Medicine Program, Hamilton General Hospital, Hamilton, Ontario, Canada 
Pages
678-683
Section
ORIGINAL ARTICLES: THROMBOSIS
Publication year
2018
Publication date
Oct 2018
Publisher
Elsevier Limited
e-ISSN
24750379
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2331417422
Copyright
© 2018. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.