Dabigatran as first-line treatment for heparin-induced thrombocytopenia in the intensive cardiac care setting

Abstract Introduction Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated disorder related to the use of unfractionated heparin (UFH) and low-molecular-weight (LMWH) which associated with increased risk vascular thrombosis. HIT constitute relevant not so uncommon clinical issue in intensive cardiac care unit setting. Parenteral non-heparin anticoagulants are recommended for treatment HIT. The efficacy dabigatran, direct oral anticoagulant, poorly documented this indication. In laboratory-confirmed only few cases short-term early conversion from another anticoagulant were reported. Purpose purpose our study was evaluate safety dabigatran as first-line one used Methods We prospectively enrolled 5 patients diagnosis who hospitalized 2017–2021. Heparin stopped immediately on suspicion off-label therapy initiated same day. There no – continuously at least 3 months. all we latex immunoassay confirm Lower-extremity compression ultrasonography performed exclude distinguished thrombosis (HITT) isolated (HIT without thrombosis). minimal follow-up period months maximal 4 years. Results All male median age 73 years (interquartile range, 52–78 years) exposed both, UFH LMWH. platelet (PLT) count before exposition 182000/μl 171000/μl–321000/μl). Platelet fall >50% observed after time 9 days 7–11 days) PLT nadir 87000 μl/l 25000/μl–103000/μl). Two had intermediate three high probability HITT diagnosed patient. manifestation upper-extremity arterial pulmonary embolism. Four recovery >15ehab724.2982/μl 2–7 days). patient HITT, complete resolution upper-limb observed. At observation end point (3 months) survived bleeding or new thrombotic event. Moreover, neither nor recurrence occurred during total period. Conclusion Dabigatran safe efficient can be challenging, scenario. Funding Acknowledgement Type funding sources: None.