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4CPS-016 Off-label use of non-heparin anticoagulants in patients with suspected acute heparin-induced thrombocytopaenia
  1. M Tomic,
  2. G Simic
  1. Clinical Centre of Serbia, Hospital Pharmacy, Belgrade, Serbia


Background Heparin-induced thrombocytopaenia (HIT) is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 (PF4) and heparin. Given the fact that HIT predisposes strongly to new episodes of thrombosis, it is not sufficient to simply discontinue the heparin administration. Generally, an alternative anticoagulant is needed to suppress the thrombotic tendency while the generation of antibodies stops and the platelet count recovers.

Purpose The aim of this study was to analyse the treatment of HIT in a clinical centre in Serbia.

Material and methods We did a retrospective descriptive study of patients with suspected acute HIT from January 2017 to September 2017. We reviewed those forms which record: diagnosis, patient demographic data, laboratory diagnosis, posology of anticoagulant and duration of therapy. All data were collected in an Excel database.

Results In this period, 39 patients with suspected acute HIT were found. Twenty-nine patients (74%) had intermediate or high clinical probability for HIT (4Tscore≥4) and all these patients were prescribed an alternative anticoagulant (27 patients had a fondaparinux in their therapy list and two patients had an apixaban on their therapy list). Both anticoagulants are factor Xa inhibitors, and both are used off-label for HIT treatment with physicians’ explanation that agents approved for this specific use are not available in Serbia.

Conclusion There is a wide fondaparinux off-label use for suspected HIT. Efficacy and safety of fondaparinux for HIT treatment require further evaluation because some case series document increased bleeding rates with this agent and its use must be carefully monitored in patients with renal compromise. Given the fact that danaparoid, bivalirudin and argatroban are not available, it is necessary to evaluate possibilities for its administrative registration in Serbia and inclusion on the list of reimbursed drugs. It is also necessary to improve our active communication with the main wards in hospitals, such as intensive care units, in order to give information to physicians about available and unavailable drugs and possibilities for their purchasing, all for the purpose of rational pharmacotherapy.

References and/or Acknowledgements 2013 Clinical Practice Guideline on the Evaluation and Management of Adults with Suspected HIT.

No conflict of interest

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