Direct oral anticoagulants for treatment of heparin-induced thrombocytopenia (HIT) and associated thromboembolism (HITT) – a systematic review and meta-analysis

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01 – Abstract Venous Symposium Europe 2024 [back to abstract list]
AUTHOR(S): George Galyfos, Alexandros Chamzin, Frangiska Sigala, Konstantinos Filis
Affiliations: Vascular Surgery Unit, First Department of Propaedeutic Surgery, National and Kapodistrian University of
Athens (NKUA), Hippocration Hospital, Greece

 

BACKGROUND/AIM

Heparin-induced thrombocytopenia (HIT) is a medical condition associated with a high risk for thrombotic complications. The role of direct oral anticoagulants (DOACs) is still emerging, and data are limited considering efficacy and safety among patients with HIT. The aim of this review is to evaluate current data on DOACs as primary or secondary treatment among patients with HIT.

METHODS

This is a systematic review utilizing PubMed, SCOPUS, and Embase online databases. Eligible studies were studies published up to July 2024 evaluating DOACs as primary or secondary treatment among patients with HIT and/or associated thrombosis (HITT). Primary outcomes that were evaluated included new thrombosis rate (NTR) and new bleeding rate (NBR) during follow-up.

RESULTS

A total of 45 publications were included (30 case reports, 5 case studies, and 10 cohort studies [n >10 patients]). Regarding treatment, 19 articles evaluated only rivaroxaban, 8 articles only apixaban, 11 articles only dabigatran, and 7 articles more than one regimen). A total of 353 patients were included. Overall, 190 patients (53.8%) were given DOAC as primary treatment whereas 163 patients were given a parenteral treatment first and continued with a DOAC. Mean nadir platelet count was 63 000/μL. HITT rate was 190/353 (53.8%; 8% had arterial thrombosis). Mean follow-up was 7.6 months. New thrombosis rate (NTR) was 20/353 (pooled proportion, 0.067 [95% confidence interval [CI], 0.044-0.094]) (30% of new thrombosis without initial thrombosis), and new bleeding rate (NBR) was 9/353 (pooled proportion, 0.041 [95% CI, 0.024- 0.064]). Finally, there was no difference found regarding NTR and NBR among different DOACs.

CONCLUSIONS

DOACs seem to have a satisfying efficacy and safety when given for patients with HIT or HITT, either as primary or secondary treatment. Outcomes seem to be similar among the different regimens. However, data are still limited, and further investigation is needed to draw safer conclusions.