Fondaparinux: another potential treatment for heparin-induced thrombocytopenia type II?

Heparin-induced thrombocytopenia (HIT) type II is a highly morbid and potentially life-threatening condition with limited treatment options in older patients at high risk of bleeding who develop acute kidney injury (AKI). The recent study by Tardy-Poncet et al. [1] showing that argatroban may be a safe and valid therapeutic option in this patient population is therefore of utmost clinical importance. However, when discussing other alternative therapies for HIT type II, the authors did not mention recent experience with fondaparinux, a selective synthetic antithrombin-mediated inhibitor of coagulation factor Xa [2]. Fondaparinux has often been used off-label to treat HIT type II in patients without AKI. Maximal treatment efficacy was obtained in all patients at an approximately sixfold less bleeding risk than in subjects treated with direct thrombin inhibitors (DTIs), including argatroban [3]. As