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Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia

BACKGROUND: The effectiveness and safety of non‐heparin anticoagulants for the treatment of heparin‐induced thrombocytopenia (HIT) are not fully established, and the optimal treatment strategy is unknown. In a systematic review and meta‐analysis, we aimed to determine precise rates of platelet recov...

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Autores principales: Nilius, Henning, Kaufmann, Jonas, Cuker, Adam, Nagler, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252596/
https://www.ncbi.nlm.nih.gov/pubmed/33857342
http://dx.doi.org/10.1002/ajh.26194
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author Nilius, Henning
Kaufmann, Jonas
Cuker, Adam
Nagler, Michael
author_facet Nilius, Henning
Kaufmann, Jonas
Cuker, Adam
Nagler, Michael
author_sort Nilius, Henning
collection PubMed
description BACKGROUND: The effectiveness and safety of non‐heparin anticoagulants for the treatment of heparin‐induced thrombocytopenia (HIT) are not fully established, and the optimal treatment strategy is unknown. In a systematic review and meta‐analysis, we aimed to determine precise rates of platelet recovery, new or progressive thromboembolism (TE), major bleeding, and death for all non‐heparin anticoagulants and to study potential sources of variability. METHODS: Following a detailed protocol (PROSPERO: CRD42020219027), EMBASE and Medline were searched for all studies reporting clinical outcomes of patients treated with non‐heparin anticoagulants (argatroban, danaparoid, fondaparinux, direct oral anticoagulants [DOAC], bivalirudin, and other hirudins) for acute HIT. Proportions of patients with the outcomes of interest were pooled using a random‐effects model for each drug. The influence of the patient population, the diagnostic test used, the study design, and the type of article was assessed. RESULTS: Out of 3194 articles screened, 92 studies with 119 treatment groups describing 4698 patients were included. The pooled rates of platelet recovery ranged from 74% (bivalirudin) to 99% (fondaparinux), TE from 1% (fondaparinux) to 7% (danaparoid), major bleeding from 1% (DOAC) to 14% (bivalirudin), and death from 7% (fondaparinux) to 19% (bivalirudin). Confidence intervals were mostly overlapping, and results were not influenced by patient population, diagnostic test used, study design, or type of article. DISCUSSION: Effectiveness and safety outcomes were similar among various anticoagulants, and significant factors affecting these outcomes were not identified. These findings support fondaparinux and DOACs as viable alternatives to conventional anticoagulants for treatment of acute HIT in clinical practice.
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spelling pubmed-82525962021-07-09 Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia Nilius, Henning Kaufmann, Jonas Cuker, Adam Nagler, Michael Am J Hematol Research Articles BACKGROUND: The effectiveness and safety of non‐heparin anticoagulants for the treatment of heparin‐induced thrombocytopenia (HIT) are not fully established, and the optimal treatment strategy is unknown. In a systematic review and meta‐analysis, we aimed to determine precise rates of platelet recovery, new or progressive thromboembolism (TE), major bleeding, and death for all non‐heparin anticoagulants and to study potential sources of variability. METHODS: Following a detailed protocol (PROSPERO: CRD42020219027), EMBASE and Medline were searched for all studies reporting clinical outcomes of patients treated with non‐heparin anticoagulants (argatroban, danaparoid, fondaparinux, direct oral anticoagulants [DOAC], bivalirudin, and other hirudins) for acute HIT. Proportions of patients with the outcomes of interest were pooled using a random‐effects model for each drug. The influence of the patient population, the diagnostic test used, the study design, and the type of article was assessed. RESULTS: Out of 3194 articles screened, 92 studies with 119 treatment groups describing 4698 patients were included. The pooled rates of platelet recovery ranged from 74% (bivalirudin) to 99% (fondaparinux), TE from 1% (fondaparinux) to 7% (danaparoid), major bleeding from 1% (DOAC) to 14% (bivalirudin), and death from 7% (fondaparinux) to 19% (bivalirudin). Confidence intervals were mostly overlapping, and results were not influenced by patient population, diagnostic test used, study design, or type of article. DISCUSSION: Effectiveness and safety outcomes were similar among various anticoagulants, and significant factors affecting these outcomes were not identified. These findings support fondaparinux and DOACs as viable alternatives to conventional anticoagulants for treatment of acute HIT in clinical practice. John Wiley & Sons, Inc. 2021-05-03 2021-07-01 /pmc/articles/PMC8252596/ /pubmed/33857342 http://dx.doi.org/10.1002/ajh.26194 Text en © 2021 The Authors. American Journal of Hematology published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Research Articles
Nilius, Henning
Kaufmann, Jonas
Cuker, Adam
Nagler, Michael
Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title_full Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title_fullStr Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title_full_unstemmed Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title_short Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
title_sort comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252596/
https://www.ncbi.nlm.nih.gov/pubmed/33857342
http://dx.doi.org/10.1002/ajh.26194
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