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Fondaparinux found to be effective in prevention of thrombotic events in patients with HIT
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Non-heparin anticoagulant fondaparinux was found to be as effective and had a similar safety profile compared with other non-heparin anticoagulants when used to prevent thrombotic events in patients with suspected or confirmed heparin-induced thrombocytopenia, according to a study published in a recent issue of Blood.
Alejandro Lazo-Langner, MD, MSc, assistant professor, departments of medicine, oncology, and epidemiology and biostatistics, University of Western Ontario, London, Ontario, Canada, told HemOnc Today this was the largest study conducted to date evaluating fondaparinux in patients with suspected heparin-induced thrombocytopenia. “Our findings suggest that this is a suitable option in patients with this condition, with the advantage of a less cumbersome administration and cost and widespread availability compared [with] other agents such as argatroban,” he said. “Additionally, the fact that it has a parenteral route of administration makes it a good candidate for patients without oral intake, as is frequently the case in these [patients]. This is important in light of the studies currently in progress evaluating oral factor Xa inhibitors for this indication.”
Alejandro Lazo-Langner
In a retrospective study, researchers in London, Ontario, Canada, assessed the efficacy and safety of fondaparinux (Arixtra, Mylan Ireland Ltd., n = 133) for the treatment of patients with suspected heparin-induced thrombocytopenia (HIT) compared with danaparoid (Orgaran, Aspen Global Incorporated, n = 59) and argatroban (Acova, GlaxoSmithKline, n = 47). They used a propensity score to match the patients administered fondaparinux to a control group of 60 patients (20 argatroban and 40 danaparoid). All patients were admitted to the London Health Sciences Centre (LHSC), London, Ontario, Canada, between February 2005 and June 2011. Primary outcomes evaluated were thrombosis or thrombosis-related death and major bleeding.
When evaluating the matched population, researchers found 22 (16.5%) episodes of thrombosis in the fondaparinux group, compared with 13 (21.4%) in the control group. When considering the safety endpoint, major bleeding occurred in 28 patients (21.1%) in the fondaparinux group, compared with 12 patients (20%) in the control group.
“The fact that a large proportion of patients received prophylactic doses is thought-provoking and raises the question of whether patients with positive antibodies directed against the PF4/heparin complex but without an overt thrombotic complication (namely venous or arterial thromboembolism or skin necrosis) need full anticoagulation,” Lazo-Langner said. – by Suzanne Bryla Reist
Disclosures: Lazo-Langner reports receiving honoraria from Boehringer Ingelheim, Leo Pharma, and Pfizer and has participated in studies sponsored by Bayer, Celgene, Daiichi-Sankyo, Leo Pharma, Novartis and Pfizer. None of these entities were involved in any aspect of this study. None of the other researchers report any conflicts of interest.
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