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Efficacy and Safety of Fondaparinux for the Management of Patients With Heparin-Induced Thrombocytopenia: A Systematic Review FREE TO VIEW

Catherine Ivory, MD; Gregoire Le Gal, MD; Marc Carrier, MD; Marc Rodger, MD; Catherine Code, MD; Esteban Gandara, MD
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Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

Chest. 2014;145(3_MeetingAbstracts):521A. doi:10.1378/chest.1835784
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Although fondaparinux is recommended by experts for the treatment of heparin- induced thrombocytopenia (HIT), recent guidelines from the American College of Chest Physicians do not support its use. In light of the aforementioned uncertainties, we conducted a systematic review to assess outcomes in HIT patients treated with fondaparinux.

METHODS: We searched electronic databases and meeting abstract books (Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE) for relevant articles reporting the outcome of patients treated with fondaparinux for serologically proven HIT. Two reviewers independently assessed the eligibility of all the articles identified in the initial search strategy. The main outcome of the study was new thrombotic events (venous or arterial) during acute treatment with fondaparinux, secondary outcomes included death, amputation and major bleeding. Pooled proportions and odds ratios (OR) were calculated using a random effect model for fondaparinux alone or compared to other alternative anticoagulants. Heterogeneity was measured using I2, and quality was measured using the Newcastle-Ottawa scale.

RESULTS: Our search retrieved 2034 articles of which 26 were further reviewed. Nine studies reporting on 151 patients treated with fondaparinux for HIT (61% of them with a thrombotic complication) were included. No randomized trials were identified, seven studies were retrospective and three studies compared fondaparinux (36 patients) and lepirudin (37 patients). The pooled proportion of new thrombosis in patients treated with fondaparinux was 3.3% (1.1-6.8;I2 4.2%) and the pooled proportion of major bleeding was 4.9% (2.1-8.8;I2 0%). One amputation and no treatment associated deaths occurred in patients treated with fondaparinux. In three studies comparing fondaparinux vs. lepirudin no differences were identified in the rate of thrombosis OR 0.69 (0.12 3.89; I2 0% ) or bleeding OR 0.82 (0.11-5.86; I2 0%). The quality of the studies included was low to moderate.

CONCLUSIONS: Limited evidence from observational studies suggests that fondaparinux could be an alternative anticoagulant for the treatment of HIT.

CLINICAL IMPLICATIONS: Compared to alternative anticoagulants used for the treatment of HIT, fondaparinux is easy to administer, does not require routine laboratory monitoring, and is relatively inexpensive. Our results call for studies comparing fondaparinux to alternative anticoagulants in patients with HIT.

DISCLOSURE: The following authors have nothing to disclose: Catherine Ivory, Gregoire Le Gal, Marc Carrier, Marc Rodger, Catherine Code, Esteban Gandara

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